Provider Demographics
NPI:1629698071
Name:SHAW-KLYMYSHYN, JENNIFER ROBIN (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBIN
Last Name:SHAW-KLYMYSHYN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-8383
Mailing Address - Country:US
Mailing Address - Phone:509-572-7204
Mailing Address - Fax:
Practice Address - Street 1:5601 COLLINS RD
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-8383
Practice Address - Country:US
Practice Address - Phone:509-572-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL42931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical