Antick, Jennifer R
Antick, Jennifer R is an individual health care provider with primary practice located at 3181 Sw Sam Jackson Park Rd Uhn 80, Portland OR 97239-3011. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Antick, Jennifer R can be contacted via phone (503) 494-7353.Contact Information
Primary practice address
3181 Sw Sam Jackson Park Rd Uhn 80
Portland OR 97239-3011
Phone: (503) 494-7353
Fax: (503) 494-3282
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PY00002039 | Washington |
Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 1853 | Oregon |
Profile Details
NPI number | 1285626507 |
---|---|
LBN Legal business name | Antick, Jennifer R |
Credentials | PHD |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Aug 22nd, 2005 |
Last updated | Dec 2nd, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1285626507 | NPPES |
Washington | MEDICAID | 7099252 |
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