Provider Demographics
NPI:1962675249
Name:HENDERSON, JENNIFER M (MS, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:JAHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8097
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0997
Mailing Address - Country:US
Mailing Address - Phone:541-821-9559
Mailing Address - Fax:
Practice Address - Street 1:328 S CENTRAL AVE STE 210
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7274
Practice Address - Country:US
Practice Address - Phone:541-821-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health