Individual
JENNIFER KAY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
150 SHELTON MCMURPHEY BLVD STE 101, EUGENE, OR 97401-5015
(541) 210-8090
(541) 210-5310
Mailing address
3995 MARCOLA RD, SPRINGFIELD, OR 97477-7948
(541) 726-1465
(541) 726-5085
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
C5663
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972620110
NPI
OR
05
—
500663059
—
OR
Enumeration date
03/23/2007
Last updated
05/28/2020
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