Provider Demographics
NPI:1598083214
Name:KRAMER, JILL L (CADC II, QMHA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:L
Last Name:KRAMER
Suffix:
Gender:F
Credentials:CADC II, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3793 RIVER RD N
Mailing Address - Street 2:A
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4827
Mailing Address - Country:US
Mailing Address - Phone:503-304-7002
Mailing Address - Fax:503-304-7049
Practice Address - Street 1:223 COMMERCIAL ST NE STE 224
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3892
Practice Address - Country:US
Practice Address - Phone:503-363-2021
Practice Address - Fax:503-304-7049
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-QMHA-I-003939101YM0800X
OR23-09-20323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health