Provider Demographics
NPI:1568002392
Name:SIEGEL, JENNIFER LIANA (CADC-1)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LIANA
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8280 NE MAUZEY CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9092
Mailing Address - Country:US
Mailing Address - Phone:503-646-5671
Mailing Address - Fax:
Practice Address - Street 1:8280 NE MAUZEY CT
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9092
Practice Address - Country:US
Practice Address - Phone:503-646-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000003996405300000X
OR22-02-10336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional