Provider Demographics
NPI:1780276774
Name:BEAUJEU, GABRIELLE JENSEN (LCSW)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:JENSEN
Last Name:BEAUJEU
Suffix:
Gender:F
Credentials:LCSW
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 431
Mailing Address - Street 2:
Mailing Address - City:NESKOWIN
Mailing Address - State:OR
Mailing Address - Zip Code:97149-0431
Mailing Address - Country:US
Mailing Address - Phone:971-340-3761
Mailing Address - Fax:
Practice Address - Street 1:272 NW MEDICAL LOOP STE E
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5545
Practice Address - Country:US
Practice Address - Phone:541-900-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL164781041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty