Provider Demographics
NPI:1043570146
Name:ROBERTS, JAEDEN MARIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:JAEDEN
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:2405 S INLAND EMPIRE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224
Mailing Address - Country:US
Mailing Address - Phone:504-621-0359
Mailing Address - Fax:
Practice Address - Street 1:2017 W. 4TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:504-621-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000069481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical