Healthcare Provider Details

I. General information

NPI: 1285287300
Provider Name (Legal Business Name): EMILY ADELE JADHAV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4392 CHERRY AVE NE
KEIZER OR
97303-4855
US

IV. Provider business mailing address

4392 CHERRY AVE NE
KEIZER OR
97303-4855
US

V. Phone/Fax

Practice location:
  • Phone: 541-399-7874
  • Fax:
Mailing address:
  • Phone: 541-399-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierTHW000003740
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON HEALTH AUTHORITY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: