Healthcare Provider Details

I. General information

NPI: 1730302563
Provider Name (Legal Business Name): JACQUELYN ANN EKERN MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11358 HIGHCREST CT
REDMOND OR
97756-7478
US

IV. Provider business mailing address

11358 HIGHCREST CT
REDMOND OR
97756-7478
US

V. Phone/Fax

Practice location:
  • Phone: 541-581-0001
  • Fax:
Mailing address:
  • Phone: 541-581-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC3250
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number62267
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: