Provider Demographics
NPI:1700304920
Name:HARSE, JESSIE LORELL (MSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LORELL
Last Name:HARSE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0506
Mailing Address - Country:US
Mailing Address - Phone:509-999-7178
Mailing Address - Fax:
Practice Address - Street 1:2222 N MONROE ST BSMT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4545
Practice Address - Country:US
Practice Address - Phone:509-999-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608093491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty