Provider Demographics
NPI:1982059606
Name:WELLS, JENNIFER JANE (PHD, MA, MA, BA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHD, MA, MA, BA
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 210
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:OR
Mailing Address - Zip Code:97431-0210
Mailing Address - Country:US
Mailing Address - Phone:541-520-6440
Mailing Address - Fax:
Practice Address - Street 1:492 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4268
Practice Address - Country:US
Practice Address - Phone:541-520-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-01
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC6282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health