- Practice location
- 880 82ND Dr, Gladstone, OR 97027-1803
- Phone
- 503-659-5515
- Fax
- 503-659-1994
- Last updated
- July 9, 2007
Jack R Agen is a Counselor, Professional based in Gladstone, OR. Jack R Agen practices in Gladstone, OR and has the professional credentials of MA. The NPI Number for Jack R Agen is 1902960362 and holds a License No. C1077 (OR). The current practice location address for Jack R Agen is 880 82ND Dr, Gladstone, OR 97027-1803 and can be reached out via phone at 503-659-5515 and via fax at 503-659-1994.
Provider Profile Details
- NPI Number
- 1902960362
- Provider Name
- Jack R Agen
- Credential
- MA
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 880 82ND Dr, Gladstone, OR 97027-1803
- Phone Number
- 503-659-5515
- Fax Number
- 503-659-1994
- Primary Taxonomy
- Counselor, Professional · 101YP2500X
- Sole Proprietor
- No
- Provider Enumeration Date
- December 20, 2006
- Last Update Date
- July 9, 2007
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 880 82ND Dr
Gladstone, OR 97027-1803 - City
- Gladstone
- State
- Oregon
- Zip
- 97027-1803
- Phone Number
- 503-659-5515
- Fax Number
- 503-659-1994
Provider Business Mailing Address Details
- Address
- Po Box 82819
Portland, OR 97282-0819 - City
- Portland
- State
- OR
- Zip
- 97282-0819
- Phone Number
- 503-233-5405
- Fax Number
- 503-233-2696
License Information
- License Number
- C1077
- License State
- OR
- Taxonomy
- Counselor, Professional · 101YP2500X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Counselor, Professional providers near Gladstone, OR
View all Counselor, Professional providers in Gladstone →Frequently Asked Questions
What is the NPI number of Jack R Agen, MA?
The NPI number of Jack R Agen, MA is 1902960362. It was assigned on December 20, 2006 and is currently active in the NPPES registry.
What is the specialty of Jack R Agen, MA?
Jack R Agen, MA is registered under the primary taxonomy Counselor, Professional (code 101YP2500X), licensed in OR under license number C1077.
Where does Jack R Agen, MA practice?
The practice location is 880 82ND Dr, Gladstone, OR 97027-1803. The office can be reached at 503-659-5515 (phone) or 503-659-1994 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1902960362 directly on the NPPES registry website.