Jacquelyn Fry
Individual provider Active NPI Social Worker · Eagle Point, OR
NPI 1992218408 · NPPES record last updated Apr 17, 2024
Key facts
- NPI
- 1992218408
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- A14436 (OR)
- Practice address
- 413 Teakwood Dr
Eagle Point, OR 97524-6608 - Phone
- (337) 509-8607
- NPI assigned
- Nov 7, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A14436 | OR | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rogue Reflection Counseling | Current |
Accepting new patients | |
| Fairway Counseling Agency, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Social Worker | 104100000X | A14436 | OR | Yes |
Addresses
Primary practice location
413 Teakwood Dr
Eagle Point, OR 97524-6608
Mailing address
413 Teakwood Dr
Eagle Point, OR 97524-6608
Other providers in Eagle Point, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.