Provider Demographics
NPI:1427412428
Name:KEPLER, JENNIFER CW (MFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CW
Last Name:KEPLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2746
Mailing Address - Country:US
Mailing Address - Phone:510-501-9527
Mailing Address - Fax:
Practice Address - Street 1:510 SW 3RD AVE
Practice Address - Street 2:STE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2543
Practice Address - Country:US
Practice Address - Phone:510-501-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT88830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist