Provider Demographics
NPI:1437741691
Name:FISHER, JENNIFER N (CSWA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:FISHER
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:N
Other - Last Name:GOODRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:YELLOWHAWK TRIBAL HEALTH CENTER
Mailing Address - Street 2:46314 TIMINE WAY
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-966-9830
Mailing Address - Fax:
Practice Address - Street 1:YELLOWHAWK TRIBAL HEALTH CENTER
Practice Address - Street 2:46314 TIMINE WAY
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA13788101YM0800X
171M00000X
ORAI3788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator