Provider Demographics
NPI:1346648110
Name:DEPRIEST, JOCELYN ANN
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ANN
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 FAIRVIEW INDUSTRIAL DR SE
Mailing Address - Street 2:150
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1180
Mailing Address - Country:US
Mailing Address - Phone:503-391-9762
Mailing Address - Fax:503-315-2019
Practice Address - Street 1:3871 FAIRVIEW INDUSTRIAL DR SE
Practice Address - Street 2:150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1180
Practice Address - Country:US
Practice Address - Phone:503-391-9762
Practice Address - Fax:503-315-2019
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-05-02101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)