Provider Demographics
NPI:1407464902
Name:PENDLETON, JAYLAH DANIELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:JAYLAH
Middle Name:DANIELLE
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 W SINTO AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3030
Mailing Address - Country:US
Mailing Address - Phone:575-740-4223
Mailing Address - Fax:
Practice Address - Street 1:4001 N COOK ST # 420
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5879
Practice Address - Country:US
Practice Address - Phone:509-747-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61355829104100000X
NMM-11357104100000X
NMX-11571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker