Provider Demographics
NPI:1699255000
Name:PRICE, JENNIFER MEGAN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MEGAN
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328-1317
Mailing Address - Country:US
Mailing Address - Phone:509-382-1164
Mailing Address - Fax:509-382-1166
Practice Address - Street 1:221 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328-1317
Practice Address - Country:US
Practice Address - Phone:509-382-1164
Practice Address - Fax:509-382-1166
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator