Provider Demographics
NPI:1457717407
Name:WHITNEY, LYNNETTE ERIN (LICSW)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:ERIN
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:ERIN
Other - Last Name:MILHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 N 11TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3085
Mailing Address - Country:US
Mailing Address - Phone:509-941-5173
Mailing Address - Fax:
Practice Address - Street 1:11 N 11TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3085
Practice Address - Country:US
Practice Address - Phone:509-941-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC605177521041C0700X
WALW608706241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2083922Medicaid