Provider Demographics
NPI:1497537559
Name:GREEN, JANELLE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10014 E VALLEYWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3717
Mailing Address - Country:US
Mailing Address - Phone:509-981-3365
Mailing Address - Fax:
Practice Address - Street 1:10014 E VALLEYWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3717
Practice Address - Country:US
Practice Address - Phone:509-981-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW612029231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical