Provider Demographics
NPI:1538779947
Name:MCLEAN, JILL RENEE (DOULA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RENEE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5068 SUMMERFIELD DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1706
Mailing Address - Country:US
Mailing Address - Phone:503-999-3253
Mailing Address - Fax:
Practice Address - Street 1:5068 SUMMERFIELD DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1706
Practice Address - Country:US
Practice Address - Phone:503-999-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000104104374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000104104Medicaid