Provider Demographics
NPI:1174687255
Name:MARIE, JEANETTE CATHERINE (MS)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:CATHERINE
Last Name:MARIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2872 CHESTER AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-2808
Mailing Address - Country:US
Mailing Address - Phone:503-589-0223
Mailing Address - Fax:503-585-4965
Practice Address - Street 1:1073 OAK ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4018
Practice Address - Country:US
Practice Address - Phone:503-585-4949
Practice Address - Fax:503-585-4965
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor