Provider Demographics
NPI:1457501124
Name:MCCONNELL, JENNIE ANN (MED)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:ANN
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6096 PINE FLAT LOOP RD
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-9426
Mailing Address - Country:US
Mailing Address - Phone:509-630-9093
Mailing Address - Fax:
Practice Address - Street 1:23 S WENATCHEE AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2264
Practice Address - Country:US
Practice Address - Phone:509-630-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60016071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health