Jennifer Kay Blake, MA

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

150 Shelton McMurphey Blvd Ste 101
Eugene, OR 97401-5015

Phone

(541) 210-8090

Fax

(541) 210-5310

NPI assigned

Mar 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 15, 2025 through Jan 15, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Madrone Mental Health Services, LLC

  • Clinical Social Worker
  • Eugene, OR
  • NPI 1124400908
  NPD (past)

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1972620110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3995 MARCOLA RD",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974777948",
            "telephone_number": "541-726-1465",
            "fax_number": "541-726-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SHELTON MCMURPHEY BLVD STE 101",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974015015",
            "telephone_number": "541-210-8090",
            "fax_number": "541-210-5310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3995 Marcola Rd",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "974777948",
            "country_code": "US",
            "telephone_number": "541-726-1465",
            "fax_number": "541-726-5085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JENNIFER",
        "middle_name": "KAY",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C5663",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500663059",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1972620110",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathaniel Blair
• Nikko Maria Navarro Blair, MS
• Kellyn Nicole Blaisdell, M.S.
• Derek Michael Blake
• Jay L Blake, NP
• Kelsey Elizabeth Blake
• Blaker Enterprises Inc
• Debra Susan Blaker, FNP
• Sagamore James Blakley, PSS
• Quinn Blanchard, PT, DPT

• Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; 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.

Verify at the official NPI Registry.