Provider Demographics
NPI:1942993159
Name:MUSIC, JACKIE (QMHA-R)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:MUSIC
Suffix:
Gender:F
Credentials:QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-0070
Mailing Address - Country:US
Mailing Address - Phone:907-378-4376
Mailing Address - Fax:
Practice Address - Street 1:1059 NW MADRAS HWY
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1416
Practice Address - Country:US
Practice Address - Phone:907-378-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist