Provider Demographics
NPI:1912102203
Name:PELTIER, JACQUELINE ANNETTE (CADC I)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANNETTE
Last Name:PELTIER
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S F ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1745
Mailing Address - Country:US
Mailing Address - Phone:541-947-3947
Mailing Address - Fax:
Practice Address - Street 1:250 S F ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1743
Practice Address - Country:US
Practice Address - Phone:541-947-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-07-37101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)