Provider Demographics
NPI:1124693379
Name:HEARN, JENNIFER A (PSS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HEARN
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 RYAN DR SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5157
Mailing Address - Country:US
Mailing Address - Phone:503-587-5151
Mailing Address - Fax:503-581-8192
Practice Address - Street 1:2995 RYAN DR SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5157
Practice Address - Country:US
Practice Address - Phone:503-587-5151
Practice Address - Fax:503-581-8192
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000004312175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist