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NPI Code Detail

MEDICARE: MS. JEANETTE CATHERINE MARIE M.S.

MEDICARE: MS. JEANETTE CATHERINE MARIE M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1174687255
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEANETTE CATHERINE MARIE M.S.
Provider Business Mailing Address
First Line : 2872 CHESTER AVE NE
Second Line :
City : SALEM
State : OR
Zip : 97303-2808
Country : US
Telephone Number : 503-589-0223
Fax Number : 503-585-4965
Provider Business Practice Location Address
First Line : 1073 OAK ST SE
Second Line :
City : SALEM
State : OR
Zip : 97301-4018
Country : US
Telephone Number : 503-585-4949
Fax Number : 503-585-4965
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 07/08/2007

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