Provider Demographics
NPI:1265052708
Name:STEINHEBEL, JESSICA A (MT-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:STEINHEBEL
Suffix:
Gender:F
Credentials:MT-BC
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 102
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-0102
Mailing Address - Country:US
Mailing Address - Phone:971-444-9311
Mailing Address - Fax:
Practice Address - Street 1:200 CEDAR ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-3740
Practice Address - Country:US
Practice Address - Phone:971-444-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR10202803225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator