Provider Demographics
NPI:1750687745
Name:BACKLUND, JENNIFER S (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:BACKLUND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 E 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3802
Mailing Address - Country:US
Mailing Address - Phone:509-993-0961
Mailing Address - Fax:509-534-8631
Practice Address - Street 1:705 W 7TH AVE
Practice Address - Street 2:SUITE 1-C
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2836
Practice Address - Country:US
Practice Address - Phone:509-993-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00005883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health