Healthcare Provider Details

I. General information

NPI: 1730228966
Provider Name (Legal Business Name): JERILEE MERKLE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 NE BAKER ST
MCMINNVILLE OR
97128-4932
US

IV. Provider business mailing address

PO BOX 1329
MCMINNVILLE OR
97128-1329
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-9797
  • Fax: 503-876-4594
Mailing address:
  • Phone: 503-472-9797
  • Fax: 503-876-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1544
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: