Healthcare Provider Details

I. General information

NPI: 1265052708
Provider Name (Legal Business Name): JESSICA A STEINHEBEL MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CEDAR ST
FAIRVIEW OR
97024-3740
US

IV. Provider business mailing address

PO BOX 102
FAIRVIEW OR
97024-0102
US

V. Phone/Fax

Practice location:
  • Phone: 971-444-9311
  • Fax:
Mailing address:
  • Phone: 971-444-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number10202803
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: