Provider Demographics
NPI:1295828721
Name:POTTERTON, JENNIFER IRENE (MSW LSW BC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:IRENE
Last Name:POTTERTON
Suffix:
Gender:F
Credentials:MSW LSW BC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:IRENE
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSW BC
Mailing Address - Street 1:5301 TIETON DRIVE SUITE C
Mailing Address - Street 2:CATHOLIC FAMILY & CHILD SERVICE
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3478
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:509-966-3478
Practice Address - Street 1:5301 TIETON DRIVE SUITE C
Practice Address - Street 2:CATHOLIC FAMILY & CHILD SERVICE
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3478
Practice Address - Country:US
Practice Address - Phone:509-965-7100
Practice Address - Fax:509-966-3478
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00038391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health