Provider Demographics
NPI:1558596775
Name:WHITE, JEANNE LAREE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:LAREE
Last Name:WHITE
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 1:5232 C ALLEN RD.
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:WA
Mailing Address - Zip Code:99173
Mailing Address - Country:US
Mailing Address - Phone:509-258-9311
Mailing Address - Fax:
Practice Address - Street 1:6228 E. OLD SCHOOL RD.
Practice Address - Street 2:
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040
Practice Address - Country:US
Practice Address - Phone:509-258-7502
Practice Address - Fax:509-258-4480
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000058691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical