MEDICARE: JENNIFER DIANE LOWRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	THW000104626	OR

General Provider Information

NPI Number	:	1013592245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DIANE LOWRY

Provider Business Mailing Address
First Line	:	PO BOX 1121
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-0254
Country	:	US
Telephone Number	:	541-440-3532
Fax Number	:	541-440-3554

Provider Business Practice Location Address
First Line	:	621 W MADRONE ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3090
Country	:	US
Telephone Number	:	541-440-3532
Fax Number	:	541-440-3554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	05/26/2026

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Directions to “ JENNIFER DIANE LOWRY ” Practice Location

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