Provider Demographics
NPI:1568008654
Name:BLAIR, JENNIFER L (QMHP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BLAIR
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 SE 8TH AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3774
Mailing Address - Country:US
Mailing Address - Phone:503-545-6798
Mailing Address - Fax:
Practice Address - Street 1:3880 SE 8TH AVE STE 180
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3774
Practice Address - Country:US
Practice Address - Phone:503-545-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-23
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500774145Medicaid