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General NPI Number Information
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NPI Number | 1215235387
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Entity Type | Individual
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Provider Name | JENNIFER PHILLIPS LMT
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Gender | Female
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 743 LAWRENCE ST
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City | EUGENE
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State | OR
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Zip | 97401
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Country | US
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Telephone | 541-343-2044
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Fax |
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Provider Business Mailing Address
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Address Line | 141 E FOURTH AVE PO BOX 68
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City | SUTHERLIN
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State | OR
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Zip | 97479-0068
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Country | US
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Telephone | 541-680-9898
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 15269
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License Number State | OR
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