MEDICARE: DR. JENNIFER ELLEN SLICKERS M.D., MPH

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
1	208000000X	Pediatrics Physician	MD27805	OR

General Provider Information

NPI Number	:	1184839979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ELLEN SLICKERS M.D., MPH

Provider Business Mailing Address
First Line	:	19550 SE STARK ST
Second Line	:	ROCKWOOD MEDICAL OFFICE
City	:	PORTLAND
State	:	OR
Zip	:	97233-5792
Country	:	US
Telephone Number	:	503-669-3900
Fax Number	:	503-669-3998

Provider Business Practice Location Address
First Line	:	19550 SE STARK ST
Second Line	:	ROCKWOOD MEDICAL OFFICE
City	:	PORTLAND
State	:	OR
Zip	:	97233-5792
Country	:	US
Telephone Number	:	503-669-3900
Fax Number	:	503-669-3998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	02/01/2022

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