Healthcare Provider Details

I. General information

NPI: 1609006873
Provider Name (Legal Business Name): JENNIFER MARIE PAINTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 NE 162ND AVE
PORTLAND OR
97230-5760
US

IV. Provider business mailing address

4405 SE HILL RD
MILWAUKIE OR
97267-1622
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-4205
  • Fax:
Mailing address:
  • Phone: 503-969-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: