Provider Demographics
NPI:1760965073
Name:KEENE, JOCELYN JAYE
Entity Type:Individual
Prefix:MISS
First Name:JOCELYN
Middle Name:JAYE
Last Name:KEENE
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 1:1531 WILTSEY RD SE APT 121
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9661
Mailing Address - Country:US
Mailing Address - Phone:503-559-7063
Mailing Address - Fax:
Practice Address - Street 1:1531 WILTSEY RD SE APT 121
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9661
Practice Address - Country:US
Practice Address - Phone:503-559-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst