Provider Demographics
NPI:1851819304
Name:JONES, CYNTHIA ANNETTE (LICSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANNETTE
Other - Last Name:DECOTEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 151
Mailing Address - Street 2:
Mailing Address - City:TOPPE
Mailing Address - State:WA
Mailing Address - Zip Code:98948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 S TOPPENISH AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1780
Practice Address - Country:US
Practice Address - Phone:509-865-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC607834841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-0576806OtherEMPLOYER