Provider Demographics
NPI:1295348480
Name:HARTLE, JANE EDEN
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:EDEN
Last Name:HARTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 SW CLAY ST APT 47
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3347
Mailing Address - Country:US
Mailing Address - Phone:907-500-2166
Mailing Address - Fax:
Practice Address - Street 1:738 NE DAVIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2931
Practice Address - Country:US
Practice Address - Phone:503-542-4603
Practice Address - Fax:503-233-6093
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker