Jennifer Alice Mandin, LCISW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LW61307762 Issued in WA

Practice address

124 E Short Ave
Spokane, WA 99202-1555

Phone

(509) 838-4651

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Jenny McClelland Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1043767049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 S DIVISION ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021510",
            "telephone_number": "509-838-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E SHORT AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021555",
            "telephone_number": "509-838-4651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1149 S Hill St",
            "address_2": "Suite H-375",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900152212",
            "country_code": "US",
            "telephone_number": "213-821-5977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANDIN",
        "first_name": "JENNIFER",
        "middle_name": "ALICE",
        "credential": "LCISW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "CG60930980",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW61307762",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC61003412",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNY",
            "last_name": "MCCLELLAND",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brandy Jane Manchester, PA
• Shannon J Mancini, M.A.
• Devyn Hallie Nathan Mandala, OD
• Benjamin Mandel, B.A. IN PSYCHOLOGY
• Mikayla J Mandere
• Alejandro Mandragon
• Karina Valhalla Mandragon, PA-C
• Michael C. Mandziara, PA
• Salil Manek, M.D
• Matthias Tolio Manene

• Social Worker in Spokane, WA
• Providers in Spokane, WA by specialty
• Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.