Provider Demographics
NPI:1104078146
Name:MUNSON, JENIFER SUE (MED)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:SUE
Last Name:MUNSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 W GRANDRIDGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6710
Mailing Address - Country:US
Mailing Address - Phone:509-619-2270
Mailing Address - Fax:509-284-4857
Practice Address - Street 1:7409 W GRANDRIDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6710
Practice Address - Country:US
Practice Address - Phone:509-619-2270
Practice Address - Fax:509-284-4857
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA60312188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health