Provider Demographics
NPI:1407403801
Name:BARTON, JENNIFER (CADC-R)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BARTON
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040A PUBLIC SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1253
Mailing Address - Country:US
Mailing Address - Phone:541-808-3553
Mailing Address - Fax:
Practice Address - Street 1:2040A PUBLIC SQUARE CT
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1253
Practice Address - Country:US
Practice Address - Phone:541-808-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-CRM-177101YA0400X
ORT-20-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)