Provider Demographics
NPI:1811177868
Name:CLOUD, JACQUELYN A (MS, CADC II)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:A
Last Name:CLOUD
Suffix:
Gender:F
Credentials:MS, CADC II
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 100
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0031
Mailing Address - Country:US
Mailing Address - Phone:541-967-3866
Mailing Address - Fax:541-812-8814
Practice Address - Street 1:2730 PACIFIC BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-5075
Practice Address - Country:US
Practice Address - Phone:541-967-3866
Practice Address - Fax:541-812-8814
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05-11-13101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)