Provider Demographics
NPI:1154110468
Name:BEAN, JENNA MARIE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:BEAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:SAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENNA SAPP
Mailing Address - Street 1:1010 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2019
Mailing Address - Country:US
Mailing Address - Phone:541-990-9143
Mailing Address - Fax:
Practice Address - Street 1:1010 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2019
Practice Address - Country:US
Practice Address - Phone:541-248-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-CRM-1559101YA0400X
ORT-25-5306101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)