Provider Demographics
NPI:1467275636
Name:POULAIN, JADE
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:POULAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 CLOVERLAWN DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-4961
Mailing Address - Country:US
Mailing Address - Phone:541-295-4321
Mailing Address - Fax:
Practice Address - Street 1:402 NW F ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1947
Practice Address - Country:US
Practice Address - Phone:541-414-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health