Provider Demographics
NPI:1710465323
Name:WELTER, JACKIE (HFS)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:WELTER
Suffix:
Gender:F
Credentials:HFS
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:WELTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:35 MULLINS DRVIE STE 3
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355
Mailing Address - Country:US
Mailing Address - Phone:541-451-6992
Mailing Address - Fax:
Practice Address - Street 1:35 MULLINS DRVIE STE 3
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355
Practice Address - Country:US
Practice Address - Phone:541-451-6992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator