Provider Demographics
NPI:1144907825
Name:MEDSKER, JENNIFER LOUISE (LSWAIC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:MEDSKER
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LOUISE
Other - Last Name:MEDSKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2386 ORIOLE ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3342
Mailing Address - Country:US
Mailing Address - Phone:703-883-7733
Mailing Address - Fax:
Practice Address - Street 1:22 FRONT ST STE F
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3443
Practice Address - Country:US
Practice Address - Phone:360-672-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61444556104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker