Provider Demographics
NPI:1962978478
Name:WOMACK, JAMIE LYNN (CP 60814393)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:WOMACK
Suffix:
Gender:F
Credentials:CP 60814393
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 W SPRAGUE
Mailing Address - Street 2:
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001
Mailing Address - Country:US
Mailing Address - Phone:509-244-6800
Mailing Address - Fax:
Practice Address - Street 1:5617 N ALBERTA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-7003
Practice Address - Country:US
Practice Address - Phone:509-218-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)