Provider Demographics
NPI:1487341319
Name:OELTJEN, JARED MATTHEW (QMHA, CRM, CADC)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:MATTHEW
Last Name:OELTJEN
Suffix:
Gender:M
Credentials:QMHA, CRM, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 OAK ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4019
Mailing Address - Country:US
Mailing Address - Phone:503-585-4949
Mailing Address - Fax:503-585-4965
Practice Address - Street 1:1118 OAK ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4019
Practice Address - Country:US
Practice Address - Phone:503-585-4949
Practice Address - Fax:503-585-4965
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
OR23-QMHA-R-4526171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist