Provider Demographics
NPI:1245359330
Name:EATON-MCNABB, JENNIFER LEE (MA, CADCI, LPC, ACS)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LEE
Last Name:EATON-MCNABB
Suffix:
Gender:F
Credentials:MA, CADCI, LPC, ACS
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CADCI, LPC, ACS
Mailing Address - Street 1:525 NW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3503
Mailing Address - Country:US
Mailing Address - Phone:503-515-8439
Mailing Address - Fax:
Practice Address - Street 1:550 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013
Practice Address - Country:US
Practice Address - Phone:503-515-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08-08-16101YA0400X
ORC2678101YM0800X, 101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator