Provider Demographics
NPI:1265901839
Name:DYER, JENNIFER M (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:DYER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:504 N NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-2728
Mailing Address - Country:US
Mailing Address - Phone:509-723-8114
Mailing Address - Fax:
Practice Address - Street 1:504 N NORTH AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-2728
Practice Address - Country:US
Practice Address - Phone:509-723-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW61116329104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker