Provider Demographics
NPI:1497272074
Name:FOURNIER, JAMIE KAY (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:KAY
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:KAY
Other - Last Name:FOURNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PEER SUPPORT SPECIAL
Mailing Address - Street 1:185 S 3RD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2082
Mailing Address - Country:US
Mailing Address - Phone:503-308-3739
Mailing Address - Fax:
Practice Address - Street 1:3716 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1111
Practice Address - Country:US
Practice Address - Phone:503-288-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist