Jernstrom, Samantha Renee

Jernstrom, Samantha Renee is an individual health care provider with primary practice located at 621 W Madrone St , Roseburg OR 97470-3090. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Behavior Technician, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Jernstrom, Samantha Renee can be contacted via phone (541) 672-2691.

Contact Information

Primary practice address
621 W Madrone St Roseburg OR 97470-3090
Phone: (541) 672-2691
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X Oregon
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X Washington
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1083232573
LBN Legal business name Jernstrom, Samantha Renee
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 10th, 2020
Last updated Apr 12th, 2022 - about 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083232573 NPPES
Oregon MEDICAID 101YM0800X

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