Healthcare Provider Details

I. General information

NPI: 1578312625
Provider Name (Legal Business Name): JENNA STENSRUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA REEVES

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HAILEY AVE STE 204
PENDLETON OR
97801-3072
US

IV. Provider business mailing address

PO BOX 882
PENDLETON OR
97801-0882
US

V. Phone/Fax

Practice location:
  • Phone: 541-663-4104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-6153
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: