Provider Demographics
NPI:1528286143
Name:JUETT, JARED E (LCSW)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:E
Last Name:JUETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0232
Mailing Address - Country:US
Mailing Address - Phone:541-440-6390
Mailing Address - Fax:541-440-6392
Practice Address - Street 1:1813 W HARVARD AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2754
Practice Address - Country:US
Practice Address - Phone:541-440-6390
Practice Address - Fax:541-440-6392
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR39461041C0700X
ORL39461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500688305Medicaid