Provider Demographics
NPI:1629767041
Name:DANCEL, JENNIFER LEANN TIERNEY MW
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEANN TIERNEY MW
Last Name:DANCEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAPU
Other - Middle Name:
Other - Last Name:DANCEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14038 SE UPPER ALDERCREST DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-1809
Mailing Address - Country:US
Mailing Address - Phone:808-264-1755
Mailing Address - Fax:
Practice Address - Street 1:825 NE 20TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2282
Practice Address - Country:US
Practice Address - Phone:503-957-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor