Provider Demographics
NPI:1477943694
Name:ELLIOTT VERMEER, JACQUELINE A (QMHA, MENTAL HEALTH)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:ELLIOTT VERMEER
Suffix:
Gender:F
Credentials:QMHA, MENTAL HEALTH
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:A
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MENTAL HEALTH COUNSE
Mailing Address - Street 1:360 CHURCH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-588-6453
Mailing Address - Fax:
Practice Address - Street 1:360 CHURCH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-588-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health