Provider Demographics
NPI:1639547060
Name:HOKE, JENNIFER INGRAM
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:INGRAM
Last Name:HOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720
Mailing Address - Country:US
Mailing Address - Phone:541-573-7303
Mailing Address - Fax:541-573-5938
Practice Address - Street 1:705 HIGHWAY 20 SOUTH
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:OR
Practice Address - Zip Code:97738
Practice Address - Country:US
Practice Address - Phone:541-573-7303
Practice Address - Fax:541-573-5938
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0176101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor