MEDICARE: EPPINGER WELLNESS 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1952129009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPPINGER WELLNESS LLC

Provider Business Mailing Address
First Line	:	2355 STATE ST # 101
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-4541
Country	:	US
Telephone Number	:	424-273-5925
Fax Number	:

Provider Business Practice Location Address
First Line	:	3123 SE 31ST AVE APT A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1981
Country	:	US
Telephone Number	:	410-693-4061
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MARRIAGE AND FAMILY THERAP
Name	:	JACQUELINE M EPPINGER
Credential	:
Telephone Number	:	410-693-4061

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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Directions to “EPPINGER WELLNESS LLC ” Practice Location

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