Jaqueline Landa

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

112881 Issued in OR

Practice address

1312 E Powell Blvd
Gresham, OR 97030-8003

Phone

(971) 706-1978

NPI assigned

Dec 18, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1356159784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SE KING RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972222891",
            "telephone_number": "971-706-1978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 E POWELL BLVD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970308003",
            "telephone_number": "971-706-1978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDA",
        "first_name": "JAQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-18",
        "last_updated": "2024-12-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "112881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tenzin Tsering Lama
• Emily Anne Lamarca, MA
• Lamb of God Clothing and Accessories
• Christina Lambert, L.AC.
• Eyerus Endale Lamore
• Carol J Landesman, PH.D.
• Michelle Rebecca Landman, OTR
• Nicole Lane, RN
• Lar Ken Enterprises, Inc.
• Heather Danielle Lara, HEATHER BENNETT, M.A

• Peer Specialist in Gresham, OR
• Providers in Gresham, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.