Provider Demographics
NPI:1548517261
Name:BURKS, JAYNEE SUE (MSW LICSW)
Entity type:Individual
Prefix:
First Name:JAYNEE
Middle Name:SUE
Last Name:BURKS
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:JAYNEE
Other - Middle Name:SUE
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12802 E SALTESE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0361
Mailing Address - Country:US
Mailing Address - Phone:509-928-7882
Mailing Address - Fax:509-928-7866
Practice Address - Street 1:12802 E SALTESE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0361
Practice Address - Country:US
Practice Address - Phone:509-928-7882
Practice Address - Fax:509-928-7866
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602510481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical