Provider Demographics
NPI:1558197830
Name:FERNANDEZ, JAMIE KAY (CADC-R)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:KAY
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 NW WATER AVE.
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2298
Mailing Address - Country:US
Mailing Address - Phone:541-371-2080
Mailing Address - Fax:
Practice Address - Street 1:213 NW WATER AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-371-2080
Practice Address - Fax:541-928-6713
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-24-4290101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)