Provider Demographics
NPI:1699363051
Name:BEALER, JENNA MARIE (MSM, CPM, LDM)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:BEALER
Suffix:
Gender:F
Credentials:MSM, CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13160 JERUSALEM HILL RD NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-9622
Mailing Address - Country:US
Mailing Address - Phone:503-315-2229
Mailing Address - Fax:503-868-7286
Practice Address - Street 1:13160 JERUSALEM HILL RD NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-9622
Practice Address - Country:US
Practice Address - Phone:503-315-2229
Practice Address - Fax:503-868-7286
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
IDMID-139176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program