Provider Demographics
NPI:1689991226
Name:STARCK, JENNIFER L (QMHP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:STARCK
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2401
Mailing Address - Country:US
Mailing Address - Phone:503-581-5535
Mailing Address - Fax:503-391-5291
Practice Address - Street 1:694 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2401
Practice Address - Country:US
Practice Address - Phone:503-581-5535
Practice Address - Fax:503-391-5291
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator