Healthcare Provider Details

I. General information

NPI: 1790001691
Provider Name (Legal Business Name): JACKIE LYNN BOGGS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACKIE LYNN LOWZIK M.S

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 OAK ALY STE 1A
EUGENE OR
97405-3692
US

IV. Provider business mailing address

2791 OAK ALY STE 1A
EUGENE OR
97405-3692
US

V. Phone/Fax

Practice location:
  • Phone: 541-692-8280
  • Fax:
Mailing address:
  • Phone: 541-692-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0934
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT0934
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: