Provider Demographics
NPI:1790364453
Name:NEVILLE, JEANIE TROMBLAY
Entity Type:Individual
Prefix:MS
First Name:JEANIE
Middle Name:TROMBLAY
Last Name:NEVILLE
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 1:12593 SE RIVER RD APT 155
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-8015
Mailing Address - Country:US
Mailing Address - Phone:218-821-4905
Mailing Address - Fax:
Practice Address - Street 1:7621 N PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5953
Practice Address - Country:US
Practice Address - Phone:503-240-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health