Basic Information
| Provider Information | |||||||||
| NPI: | 1265680524 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | JOANNE | ||||||||
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| Credential: | MSW, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7408 SE CLAY ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972153531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034425491 | ||||||||
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| Practice Location | |||||||||
| Address1: | 58646 MCNULTY WAY | ||||||||
| Address2: | |||||||||
| City: | SAINT HELENS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970516210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033975211 | ||||||||
| FaxNumber: | 5033975373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2008 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | A3451 | OR | N | Behavioral Health & Social Service Providers | Counselor | 163W00000X | 200842224RN | OR | N | Nursing Service Providers | Registered Nurse | 163WH0200X | 200842224RN | OR | N | Nursing Service Providers | Registered Nurse | Home Health | 163WP0809X | 200842224RN | OR | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.