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General NPI Number Information
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NPI Number | 1992680177
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Entity Type | Individual
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Provider Name | JILLIAN MARGUERITE MOORE CRM
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Gender | Female
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 200 SE HAILEY AVE STE 204
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City | PENDLETON
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State | OR
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Zip | 97801-3072
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Country | US
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Telephone | 541-663-4104
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Fax | 541-663-4142
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Provider Business Mailing Address
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Address Line | 1275 W MADRONA AVE APT B
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City | HERMISTON
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State | OR
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Zip | 97838-1445
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Country | US
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Telephone | 541-314-5570
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 25-CRM-4289
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License Number State | OR
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