Opgenorth, Jack
Opgenorth, Jack is an sole proprietor health care provider with primary practice located at 1744 E Mcandrews Rd Suite B, Medford OR 97504. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Opgenorth, Jack can be contacted via phone (541) 776-0821.Contact Information
Primary practice address
1744 E Mcandrews Rd Suite B
Medford OR 97504
Phone: (541) 776-0821
Fax: (541) 776-5011
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | L2954 | Oregon |
Profile Details
| NPI number | 1376679969 |
|---|---|
| LBN Legal business name | Opgenorth, Jack |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 26th, 2007 |
| Last updated | Feb 11th, 2016 - about 8 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 | 1376679969 | NPPES |
| Oregon | Other | L2954 | LICENSE NUMBER |
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