MEDICARE: MRS. JACQUELINE MARIE MULAR MS, RD, LMFT

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	133V00000X	Registered Dietitian	10175520	OR
2	106H00000X	Marriage & Family Therapist	T1459	OR

General Provider Information

NPI Number	:	1508335704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE MARIE MULAR MS, RD, LMFT

Provider Business Mailing Address
First Line	:	4 TOUCHSTONE APT 107
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-1963
Country	:	US
Telephone Number	:	323-496-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	20255 WILLAMETTE DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-2027
Country	:	US
Telephone Number	:	323-496-5552
Fax Number	:	503-715-4918

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

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	03/18/2026

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