Provider Demographics
NPI:1184000911
Name:JENNIFER MEANS ND LAC PC
Entity Type:Organization
Organization Name:JENNIFER MEANS ND LAC PC
Other - Org Name:SINGING RIVER NATURAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, PRESIDENT, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, MACOM
Authorized Official - Phone:503-641-6400
Mailing Address - Street 1:4970 SW MAIN AVE # 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2740
Mailing Address - Country:US
Mailing Address - Phone:503-641-6400
Mailing Address - Fax:503-641-6401
Practice Address - Street 1:4970 SW MAIN AVE # 100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2740
Practice Address - Country:US
Practice Address - Phone:503-641-6400
Practice Address - Fax:503-641-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR857261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226292Medicaid