Healthcare Provider Details

I. General information

NPI: 1235674136
Provider Name (Legal Business Name): BREATHE EASY WITH JENN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MARKET ST NE STE 541
SALEM OR
97301-1835
US

IV. Provider business mailing address

3000 MARKET ST NE STE 541
SALEM OR
97301-1835
US

V. Phone/Fax

Practice location:
  • Phone: 971-301-8309
  • Fax: 971-301-8310
Mailing address:
  • Phone: 971-301-8309
  • Fax: 971-301-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberRT-P-10135828
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License NumberRT-P-10135828
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN BALDWIN
Title or Position: CHIEF OPERATING OFFICER
Credential: RRT
Phone: 971-301-8309