Provider Demographics
NPI:1023722121
Name:TEMPLE, ELIZABETH MARIE JAEGER (INTERN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE JAEGER
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:TEMPLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7346 NE SANDY BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5775
Mailing Address - Country:US
Mailing Address - Phone:503-746-3373
Mailing Address - Fax:
Practice Address - Street 1:7346 NE SANDY BLVD APT C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5775
Practice Address - Country:US
Practice Address - Phone:503-746-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health