Provider Demographics
NPI:1962116152
Name:PFAFF, JAYLENE (LICSWA, MSW)
Entity type:Individual
Prefix:
First Name:JAYLENE
Middle Name:
Last Name:PFAFF
Suffix:
Gender:F
Credentials:LICSWA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SIMPSON PKWY APT 638
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-5012
Mailing Address - Country:US
Mailing Address - Phone:435-799-9009
Mailing Address - Fax:
Practice Address - Street 1:1008 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2237
Practice Address - Country:US
Practice Address - Phone:509-413-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61340819104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker