JACQUELINE GREEN (NPI# 1659732642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659732642 |
| Entity Type | Individual |
| Full Name | JACQUELINE GREEN |
| Practice Address |
1599 State St Salem OR 97301-4255 |
| Practice Telephone | 5033633260 |
| Practice Fax Number | 5035850491 |
| Mailing Telephone | 5033633260 |
| Mailing Fax Number | 5035850491 |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2016-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | OR | Other Service Providers | |
| Y | 175T00000X | Peer Specialist | OR | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386189728 | Jacqueline Green | Occupational Therapist | 4703 W Braddock Rd Apt 30, Alexandria, VA 22311-4706 | 2016-12-20 |
| 1598116204 | Jacqueline Green | Technician, Other | 221 Flowerdale St, Ferndale, MI 48220-1875 | 2016-06-23 |
| 1912230798 | Jacqueline Marie Green | Specialist | 37 Sandpiper Cir, Ormond Beach, FL 32174-6042 | 2009-09-11 |
| 1508401688 | Jacqueline Green | Community Health Worker | 1775 Grand Concourse, Bronx, NY 10453-8202 | 2019-11-12 |
| 1962980094 | Jacqueline Green | Home Health Aide | 9846 Hwy 31 E, Tyler, TX 75705-2329 | 2018-07-31 |
| 1306348487 | Jacqueline Priscilla Green | Nurse Practitioner | 717 Pratt Ave Ne, Huntsville, AL 35801-3645 | 2018-03-05 |
| 1568866648 | Jacqueline Green | Specialist | 4117 Nw 122nd St Ste C, Oklahoma City, OK 73120-8878 | 2014-10-17 |
| 1871937193 | Jacqueline M Green | Counselor | 3444 Wisconsin Ave, Vicksburg, MS 39180-5331 | 2013-04-18 |
| 1578816138 | Jacqueline Marie Green | Clinical Nurse Specialist | 125 Paterson St, Clinical Academic Building Suite 6176, New Brunswick, NJ 08901-1962 | 2012-10-19 |
| 1477831758 | Jacqueline Green | Social Worker | 10 Peterboro St, Detroit, MI 48201-2722 | 2011-08-03 |
| Street Address |
1599 STATE ST |
| City | SALEM |
| State | OR |
| Zip Code | 97301-4255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336552124 | Nancy Snider | Social Worker | 1599 State St, Salem, OR 97301-4255 | 2014-06-09 |
| 1043772411 | Jill R Bird | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2019-04-03 |
| 1730647975 | Dallas Eddington | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2019-03-06 |
| 1669951745 | Rana Mccollam | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2018-08-09 |
| 1417462243 | Joe Conklin | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2017-12-01 |
| 1366957193 | Kenneth Sundrud | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2017-12-01 |
| 1740794577 | Corry Austin | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2017-12-01 |
| 1457865289 | Edward Berrigan | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2017-12-01 |
| 1215455399 | Lynette Paulson | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2017-09-08 |
| 1922526086 | Steven Moore | Peer Specialist | 1599 State St, Salem, OR 97301-4255 | 2017-09-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205450970 | Jehan Seals | Behavior Technician | 3400 State St Set G750, Salem, OR 97301 | 2020-05-29 |
| 1093335929 | Sterling Recovery, LLC | Dietitian, Registered | 3758 Amber St Ne #105, Salem, OR 97301 | 2020-04-21 |
| 1760018360 | Riverfront Mental Health LLC | Counselor | 338 State St, Suite 985, Salem, OR 97301 | 2020-03-16 |
| 1871126888 | Amity Beth Haddon Maxwell | Social Worker | Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 | 2020-02-18 |
| 1861042632 | Brenda Grizelda Vargas | Behavioral Analyst | 3400 State Ste Ste G750, Salem, OR 97301 | 2019-09-13 |
| 1588213177 | Natalie Stone | Registered Nurse | 2045 Siverton Rd Ne, Salem, OR 97301 | 2019-09-06 |
| 1588228720 | Jeramy Disenso | Counselor | 270 Cottage St Ne, Salem, OR 97301 | 2019-04-23 |
| 1801353297 | Gwendolyn Kersey | Registered Nurse | 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 | 2019-02-21 |
| 1841769114 | Spine Clinic PC | Massage Therapist | 1281 Lancaster Drive Ne, Salem, OR 97301 | 2018-11-16 |
| 1013482132 | Kellie Linn Hansen | Physical Therapist | 4049 Market St Se, Salem, OR 97301 | 2018-10-04 |
| Find all providers in zip 97301 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528677820 | Charice Monette | Peer Specialist | 4151 Kacey Cir Ne, Salem, OR 97305-4504 | 2020-07-23 |
| 1821649336 | Christopher Adam Handy | Peer Specialist | 3050 Park Ave Ne, Salem, OR 97301-8615 | 2019-09-25 |
| 1922505767 | Amy Nicole Cozad | Peer Specialist | 4275 Commercial St Se Ste 180, Salem, OR 97302-4087 | 2018-04-09 |
| 1649785817 | Keileigh Joy Dull | Peer Specialist | 3213 Center St Ne, Salem, OR 97301-4666 | 2017-12-08 |
| 1104331370 | Christina E Higgins Korkow | Peer Specialist | 2555 Silverton Rd Ne, Salem, OR 97301-0837 | 2017-12-08 |
| 1437682044 | Debra Janae Rice | Peer Specialist | 2555 Silverton Rd Ne Ste C, Salem, OR 97301-0837 | 2017-04-10 |
| 1952834194 | Brian Smith | Peer Specialist | 769 Hawthorne Ave Ne, Salem, OR 97301-4623 | 2017-04-05 |
| 1588013577 | Sarah Harris | Peer Specialist | 4255 32nd Pl Ne, Salem, OR 97301-6735 | 2016-06-09 |
| 1194187476 | Tammi Paul | Peer Specialist | 1300 Broadway St Ne Ste 403, Salem, OR 97301-1420 | 2016-03-24 |
| 1710343926 | Teresa Anne Sims | Peer Specialist | 1599 State Street Ne, Salem, OR 97301 | 2016-01-05 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.