Provider Demographics
NPI:1992917595
Name:STRAUGHAN, JENNI LYNNE
Entity type:Individual
Prefix:
First Name:JENNI
Middle Name:LYNNE
Last Name:STRAUGHAN
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 1:807 FERGUSON STREET
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:COLTON
Mailing Address - State:WA
Mailing Address - Zip Code:99113
Mailing Address - Country:US
Mailing Address - Phone:509-229-3375
Mailing Address - Fax:
Practice Address - Street 1:807 FERGUSON STREET
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:WA
Practice Address - Zip Code:99113
Practice Address - Country:US
Practice Address - Phone:509-229-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002065000Medicaid
ID002065100Medicaid