Active NPI
Jaqulyn L Tasker, LPC
- Professional Counselor
- Corvallis, OR
National Provider Identifier
1194883025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C1632
- Practice address
- 530 NW 27TH St
Corvallis, OR 97330-5223 - Phone
- (541) 766-6835
- Fax
- (541) 766-6186
- NPI assigned
- Dec 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C1632 | OR | Primary |
Addresses
Primary practice location
530 NW 27TH St
Corvallis, OR 97330-5223
Mailing address
PO Box 579
Corvallis, OR 97339-0579
Phone (541) 766-6835
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C1632 | Other | OR | LICENSED PROF. COUNSELOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 12, 2024 through Apr 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1632 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194883025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 579",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973390579",
"telephone_number": "541-766-6835",
"fax_number": "541-766-6186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 NW 27TH ST",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973305223",
"telephone_number": "541-766-6835",
"fax_number": "541-766-6186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TASKER",
"first_name": "JAQULYN",
"middle_name": "L",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1632",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED PROF. COUNSELOR",
"identifier": "C1632",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.