MEDICARE: JENNIFER WEEKS MS LPC LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	C4552	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639687809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER WEEKS MS LPC LLC

Provider Business Mailing Address
First Line	:	1104 NE REVERE AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4150
Country	:	US
Telephone Number	:	541-480-9443
Fax Number	:

Provider Business Practice Location Address
First Line	:	61533 PARRELL RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-2701
Country	:	US
Telephone Number	:	541-480-9443
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER B WEEKS
Credential	:	LPC
Telephone Number	:	541-480-9443

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	02/28/2018

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