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NPI Code Detail

MEDICARE: FATIMA JALLOH

MEDICARE: FATIMA JALLOH
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
1101YM0800XMental Health Counselor
2101YM0800XMental Health Counselor1041C0700XOR
31041C0700XClinical Social WorkerL11796OR

General Provider Information

NPI Number : 1922612035
Entity Type Code : Individual
Provider Name (Legal Business Name) : FATIMA JALLOH
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 : 3005 NE DIAMOND LAKE BLVD
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-3609
Country : US
Telephone Number : 541-440-3532
Fax Number : 541-440-3554
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2020
Last Update Date : 09/23/2024

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Directions to “ FATIMA JALLOH ” Practice Location

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