Provider Demographics
NPI:1427381573
Name:CRACKENBERG, JENNIFER EILEEN (LPC, CADCI)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EILEEN
Last Name:CRACKENBERG
Suffix:
Gender:F
Credentials:LPC, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 NE DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4716
Mailing Address - Country:US
Mailing Address - Phone:503-472-4020
Mailing Address - Fax:
Practice Address - Street 1:617 NE DAVIS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4716
Practice Address - Country:US
Practice Address - Phone:503-472-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ORC3769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)