Provider Demographics
NPI:1295828721
Name:POTTERTON, JENNIFER IRENE (MSW LICSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:IRENE
Last Name:POTTERTON
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:IRENE
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSW BC
Mailing Address - Street 1:2610 OCEAN BEACH HWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3508
Mailing Address - Country:US
Mailing Address - Phone:360-208-1778
Mailing Address - Fax:509-966-3478
Practice Address - Street 1:2610 OCEAN BEACH HWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3508
Practice Address - Country:US
Practice Address - Phone:360-208-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601241091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical