Provider Demographics
NPI:1497994115
Name:EATON-BENNETTE, JANICE (MSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:EATON-BENNETTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 SW MURRAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2454
Mailing Address - Country:US
Mailing Address - Phone:503-352-0045
Mailing Address - Fax:503-352-0790
Practice Address - Street 1:3900 SW MURRAY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2454
Practice Address - Country:US
Practice Address - Phone:503-352-0045
Practice Address - Fax:503-352-0790
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical