Provider Demographics
NPI:1760032536
Name:LANDGRAF, JENELLE D
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:D
Last Name:LANDGRAF
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:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-0592
Mailing Address - Country:US
Mailing Address - Phone:509-508-1256
Mailing Address - Fax:
Practice Address - Street 1:11779 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1362
Practice Address - Country:US
Practice Address - Phone:509-508-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical