Basic Information
| Provider Information | |||||||||
| NPI: | 1932534641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LEA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAXSON | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LEA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 900 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975047136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418427704 | ||||||||
| FaxNumber: | 5418427640 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 N PLATT AVE | ||||||||
| Address2: | |||||||||
| City: | EAGLE POINT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975248618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418306617 | ||||||||
| FaxNumber: | 5414141925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2013 | ||||||||
| LastUpdateDate: | 10/04/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C4637 | OR | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | C4637 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.