Provider Demographics
NPI:1770550881
Name:BATEMAN, JEANNETTE RUTH (MSW)
Entity type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:RUTH
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JEANNETTE
Other - Middle Name:RUTH
Other - Last Name:DEZSOFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2114 MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2674
Mailing Address - Country:US
Mailing Address - Phone:360-695-7588
Mailing Address - Fax:360-695-2982
Practice Address - Street 1:3305 MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2251
Practice Address - Country:US
Practice Address - Phone:360-695-7588
Practice Address - Fax:360-695-2982
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000053461041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8915309OtherCRIME VICTIMS
166362OtherVALUE OPTIONS