Provider Demographics
NPI:1477690121
Name:KASSNER, JAMIE MICHELLE (AA)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:MICHELLE
Last Name:KASSNER
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-9559
Mailing Address - Country:US
Mailing Address - Phone:503-881-6821
Mailing Address - Fax:
Practice Address - Street 1:1292 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-9559
Practice Address - Country:US
Practice Address - Phone:503-881-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator