Healthcare Provider Details

I. General information

NPI: 1366850034
Provider Name (Legal Business Name): MARY KAY JABS MSW, CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 NW MEDICAL LOOP STE E
ROSEBURG OR
97471-5545
US

IV. Provider business mailing address

770 SE KANE ST
ROSEBURG OR
97470-3943
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-4285
  • Fax: 888-810-2993
Mailing address:
  • Phone: 541-464-6455
  • Fax: 541-464-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: