Provider Demographics
NPI:1336629989
Name:HAMLIN, JENNY LYNN (CPRM)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:CPRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 DELTA WATERS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5852
Mailing Address - Country:US
Mailing Address - Phone:541-772-4648
Mailing Address - Fax:541-858-7593
Practice Address - Street 1:3397 DELTA WATERS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5852
Practice Address - Country:US
Practice Address - Phone:542-772-4648
Practice Address - Fax:541-858-7593
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-CRM-253175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist