Provider Demographics
NPI:1063862373
Name:EILERMANN, JANA (BA, WFR, QMHP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:EILERMANN
Suffix:
Gender:F
Credentials:BA, WFR, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SW LOBELIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4740
Mailing Address - Country:US
Mailing Address - Phone:513-240-4747
Mailing Address - Fax:
Practice Address - Street 1:619 SW LOBELIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4740
Practice Address - Country:US
Practice Address - Phone:513-240-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health