Basic Information
| Provider Information | |||||||||
| NPI: | 1831398544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JASPER | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | BS, QMHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18728 S ABIQUA RD NE | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973818900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038739259 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2421 LANCASTER DR NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885352 | ||||||||
| FaxNumber: | 5035854990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.