Provider Demographics
NPI:1134877970
Name:JEN, MORENE
Entity type:Individual
Prefix:
First Name:MORENE
Middle Name:
Last Name:JEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6975 SW SANDBURG ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8089
Mailing Address - Country:US
Mailing Address - Phone:814-243-0414
Mailing Address - Fax:
Practice Address - Street 1:6975 SW SANDBURG ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8089
Practice Address - Country:US
Practice Address - Phone:814-243-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR999999999Medicaid