Provider Demographics
NPI:1154638070
Name:WASSERMILLER, JENNIFER GWEN (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GWEN
Last Name:WASSERMILLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 OLIVE ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2642
Mailing Address - Country:US
Mailing Address - Phone:541-543-7673
Mailing Address - Fax:
Practice Address - Street 1:576 OLIVE ST
Practice Address - Street 2:SUITE 307
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2642
Practice Address - Country:US
Practice Address - Phone:541-543-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORA22231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health