Provider Demographics
NPI:1376745174
Name:JAQUES, LINDSAY NICHOLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:NICHOLE
Last Name:JAQUES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15378 SE PARK TREE DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5428
Mailing Address - Country:US
Mailing Address - Phone:503-319-0678
Mailing Address - Fax:503-427-0900
Practice Address - Street 1:2478 13TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2546
Practice Address - Country:US
Practice Address - Phone:503-561-5582
Practice Address - Fax:503-561-2707
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional