Provider Demographics
NPI:1316458342
Name:WHITTAKER, JANNA
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7136
Mailing Address - Country:US
Mailing Address - Phone:541-842-7705
Mailing Address - Fax:541-842-7640
Practice Address - Street 1:203 N PLATT AVE
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8618
Practice Address - Country:US
Practice Address - Phone:541-773-3863
Practice Address - Fax:541-500-8171
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional