Antick, Jennifer R

Antick, Jennifer R is an individual health care provider with primary practice located at 3181 Sw Sam Jackson Park Rd Uhn 80, Portland OR 97239-3011. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Antick, Jennifer R can be contacted via phone (503) 494-7353.

Contact Information

Primary practice address
3181 Sw Sam Jackson Park Rd Uhn 80 Portland OR 97239-3011
Phone: (503) 494-7353
Fax: (503) 494-3282
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PY00002039 Washington
Behavioral Health & Social Service Providers / Clinical 103TC0700X 1853 Oregon

Profile Details

NPI number 1285626507
LBN Legal business name Antick, Jennifer R
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2005
Last updated Dec 2nd, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285626507 NPPES
Washington MEDICAID 7099252

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