Healthcare Provider Details

I. General information

NPI: 1962716936
Provider Name (Legal Business Name): EMILY ANNE JENKINS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY ANNE BRYAN M.A.

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S MAIN ST
LEBANON OR
97355-3109
US

IV. Provider business mailing address

PO BOX 100
ALBANY OR
97321-0031
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-5932
  • Fax:
Mailing address:
  • Phone: 541-967-3866
  • Fax: 541-812-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: