Provider Demographics
NPI:1285329763
Name:STEGENGA, JULIANA ZAJICEK (LICSW-A)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:ZAJICEK
Last Name:STEGENGA
Suffix:
Gender:F
Credentials:LICSW-A
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:NICOLE
Other - Last Name:ZAJICEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:1919 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2347
Practice Address - Country:US
Practice Address - Phone:509-747-3081
Practice Address - Fax:509-455-8462
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615255021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical