Healthcare Provider Details

I. General information

NPI: 1962164343
Provider Name (Legal Business Name): JORDYN ROBERTS HOHSTADT LMFT ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NW 2ND ST
CORVALLIS OR
97330-6442
US

IV. Provider business mailing address

585 SE VIEWMONT AVE
CORVALLIS OR
97333-1903
US

V. Phone/Fax

Practice location:
  • Phone: 541-203-0523
  • Fax:
Mailing address:
  • Phone: 541-203-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: