Provider Demographics
NPI:1932534641
Name:THORER, JENNIFER LEA
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEA
Last Name:THORER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LEA
Other - Last Name:PAXSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7136
Mailing Address - Country:US
Mailing Address - Phone:541-842-7704
Mailing Address - Fax:541-842-7640
Practice Address - Street 1:203 N PLATT AVE
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8618
Practice Address - Country:US
Practice Address - Phone:541-830-6617
Practice Address - Fax:541-414-1925
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4637101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional