Provider Demographics
NPI:1356518302
Name:MALEY, JENNIFER CAROL (IMF)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CAROL
Last Name:MALEY
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:CAROL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMF
Mailing Address - Street 1:1483 POPLAR DR
Mailing Address - Street 2:APT. 6
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5286
Mailing Address - Country:US
Mailing Address - Phone:760-277-5921
Mailing Address - Fax:
Practice Address - Street 1:695 MISTLETOE RD
Practice Address - Street 2:SUITE H
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9552
Practice Address - Country:US
Practice Address - Phone:541-482-8906
Practice Address - Fax:541-482-6462
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist