Provider Demographics
NPI:1366289696
Name:EGAN, JENNIFER UPTON (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:UPTON
Last Name:EGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11260 CORP RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-8802
Mailing Address - Country:US
Mailing Address - Phone:541-282-3105
Mailing Address - Fax:
Practice Address - Street 1:11260 CORP RANCH RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-8802
Practice Address - Country:US
Practice Address - Phone:541-282-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional