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General NPI Number Information
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NPI Number | 1972979334
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Entity Type | Individual
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Provider Name | JERMAINE SIMPKINS M.A
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Gender | Male
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 3005 NE DIAMOND LAKE BLVD
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City | ROSEBURG
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State | OR
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Zip | 97470-3609
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Country | US
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Telephone | 702-427-1195
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1121
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City | ROSEBURG
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State | OR
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Zip | 97470-0254
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Country | US
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Telephone | 702-427-1195
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OR
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