Provider Demographics
NPI:1285288167
Name:OBERENDER, JEREMY DAMON (MSW, SUDP, LICSWA, M)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:DAMON
Last Name:OBERENDER
Suffix:
Gender:
Credentials:MSW, SUDP, LICSWA, M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 W HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1713
Mailing Address - Country:US
Mailing Address - Phone:509-315-7312
Mailing Address - Fax:
Practice Address - Street 1:622 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2202
Practice Address - Country:US
Practice Address - Phone:509-960-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61156622101YA0400X
WASC61572929101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health