Provider Demographics
NPI:1780303578
Name:PICANSO-SUTTON, JENNIFER M (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:PICANSO-SUTTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2635
Mailing Address - Country:US
Mailing Address - Phone:559-331-0003
Mailing Address - Fax:
Practice Address - Street 1:2191 MARION ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2314
Practice Address - Country:US
Practice Address - Phone:541-378-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000013867104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker