Provider Demographics
NPI:1346086394
Name:CORT, JENNIFER CRYSTAL
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CRYSTAL
Last Name:CORT
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 1:2625 E ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4456
Mailing Address - Country:US
Mailing Address - Phone:541-604-0992
Mailing Address - Fax:
Practice Address - Street 1:755 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3313
Practice Address - Country:US
Practice Address - Phone:541-604-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health