Healthcare Provider Details

I. General information

NPI: 1336241181
Provider Name (Legal Business Name): JENNIFER OBERMEYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST SUITE 100
GRESHAM OR
97080-2329
US

IV. Provider business mailing address

4101 NE DIVISION ST SUITE 100
GRESHAM OR
97030-4617
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-3808
  • Fax: 503-666-6835
Mailing address:
  • Phone: 503-666-3808
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: