Provider Demographics
NPI:1659520328
Name:FEDOROV, JENNIFER RACHEL (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RACHEL
Last Name:FEDOROV
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:RACHEL
Other - Last Name:BURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:767 WILLAMETTE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2952
Mailing Address - Country:US
Mailing Address - Phone:541-232-6680
Mailing Address - Fax:541-343-2442
Practice Address - Street 1:767 WILLAMETTE ST
Practice Address - Street 2:SUITE301
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2952
Practice Address - Country:US
Practice Address - Phone:541-232-6680
Practice Address - Fax:541-343-2442
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist