Provider Demographics
NPI:1205130473
Name:BRIGGS, JENNIFER ROBYN (AUD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBYN
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12724 SE STARK ST BLDG H
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1539
Mailing Address - Country:US
Mailing Address - Phone:971-270-2147
Mailing Address - Fax:503-253-2895
Practice Address - Street 1:12724 SE STARK ST BLDG H
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1539
Practice Address - Country:US
Practice Address - Phone:971-270-2147
Practice Address - Fax:503-253-2895
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60207178231H00000X
OR022511231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500634708Medicaid
OR500634708Medicaid