Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | SC61004013 | WA |
NPI | 1003457201 |
---|---|
Provider Name | Jenelee Sue Fross |
First Address | Spokane, WA 99201-0206 |
Second Address | Spokane, WA 99201-0206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2019 |
Last Update Date | 30/09/2019 |