Provider Demographics
NPI:1730302563
Name:EKERN, JACQUELYN ANN (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:ANN
Last Name:EKERN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11358 HIGHCREST CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7478
Mailing Address - Country:US
Mailing Address - Phone:541-581-0001
Mailing Address - Fax:
Practice Address - Street 1:11358 HIGHCREST CT
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7478
Practice Address - Country:US
Practice Address - Phone:541-581-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3250101Y00000X
TX62267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor