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NPI Code Detail

MEDICARE: JENNIFER NELSON

MEDICARE: JENNIFER NELSON
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1184587388
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER NELSON
Provider Business Mailing Address
First Line : 1515 OLD FORT RD
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-9374
Country : US
Telephone Number : 336-209-8103
Fax Number :
Provider Business Practice Location Address
First Line : 1515 OLD FORT RD
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-9374
Country : US
Telephone Number : 336-209-8103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/04/2025

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