Healthcare Provider Details

I. General information

NPI: 1972832939
Provider Name (Legal Business Name): JENNIFER M KRUMM MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10883 SE MAIN ST SUITE 206
MILWAUKIE OR
97222-7641
US

IV. Provider business mailing address

10883 MAIN STREET, SUITE 206
MILWAUKIE OR
97222-7759
US

V. Phone/Fax

Practice location:
  • Phone: 503-867-2982
  • Fax:
Mailing address:
  • Phone: 503-867-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2108
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: