Provider Demographics
NPI:1780857524
Name:UNGARWULFF, JENNIFER (BMT)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:UNGARWULFF
Suffix:
Gender:F
Credentials:BMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N 1ST ST STE 12
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1677
Mailing Address - Country:US
Mailing Address - Phone:971-258-1494
Mailing Address - Fax:
Practice Address - Street 1:104 N 1ST ST STE 12
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1677
Practice Address - Country:US
Practice Address - Phone:971-258-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
ORC5782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist