Provider Demographics
NPI:1912129354
Name:BECKER, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22180 OLYMPIC COLLEGE WAY NW STE 102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6664
Mailing Address - Country:US
Mailing Address - Phone:360-779-4444
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:853 N CHURCH ST
Practice Address - Street 2:SUITE 720A
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3098
Practice Address - Country:US
Practice Address - Phone:864-560-6844
Practice Address - Fax:864-560-7015
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35487207RR0500X
CT49636207RR0500X
SCTL35487207RR0500X
WAMD60795325207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01194322OtherRAILROAD MEDICARE
SC354878Medicaid
WA2094534Medicaid