Healthcare Provider Details

I. General information

NPI: 1982059606
Provider Name (Legal Business Name): JENNIFER JANE WELLS PH.D., MA, MA, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2016
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 E 13TH AVE
EUGENE OR
97401-4268
US

IV. Provider business mailing address

PO BOX 210
DEXTER OR
97431-0210
US

V. Phone/Fax

Practice location:
  • Phone: 541-520-6440
  • Fax:
Mailing address:
  • Phone: 541-520-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC6282
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: