Provider Demographics
NPI:1952683146
Name:BOLAND, JORDAIN ELAINE (MS, QMHP)
Entity Type:Individual
Prefix:
First Name:JORDAIN
Middle Name:ELAINE
Last Name:BOLAND
Suffix:
Gender:F
Credentials:MS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15544 S CLACKAMAS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9490
Mailing Address - Country:US
Mailing Address - Phone:503-974-5819
Mailing Address - Fax:
Practice Address - Street 1:15544 S CLACKAMAS RIVER ROAD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2721
Practice Address - Country:US
Practice Address - Phone:503-974-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health