Provider Demographics
NPI:1124448873
Name:BLACKBURN, JELENA
Entity type:Individual
Prefix:DR
First Name:JELENA
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:1000 WILLAGILLESPIE RD STE 175
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7106
Mailing Address - Country:US
Mailing Address - Phone:541-238-2108
Mailing Address - Fax:
Practice Address - Street 1:1000 WILLAGILLESPIE STE.175
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6003
Practice Address - Country:US
Practice Address - Phone:541-238-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2021175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath