Provider Demographics
NPI:1538926902
Name:FAKHRY, JENNIFER MARIE (CADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:FAKHRY
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13199 SW NICOLE LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1820
Mailing Address - Country:US
Mailing Address - Phone:503-481-1878
Mailing Address - Fax:
Practice Address - Street 1:211 NE 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2822
Practice Address - Country:US
Practice Address - Phone:971-351-0914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)