Provider Demographics
NPI:1811267495
Name:PAGE, JODI LOUISE (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LOUISE
Last Name:PAGE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RIVER LOOP 2
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3512
Mailing Address - Country:US
Mailing Address - Phone:541-556-8846
Mailing Address - Fax:
Practice Address - Street 1:7080 SW FIR LOOP STE 100
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8149
Practice Address - Country:US
Practice Address - Phone:503-620-1191
Practice Address - Fax:503-620-3940
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional