Jack R Agen, MA
Counselor, Professional in Gladstone, Oregon
1902960362- 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, MA is a Counselor, Professional based in Gladstone, OR. Jack R Agen, MA holds the professional credentials of MA. The NPI number for Jack R Agen, MA is 1902960362 and holds license No. C1077 (OR). The current practice location address is 880 82ND Dr, Gladstone, OR 97027-1803 and the office can be reached by phone at 503-659-5515 and by fax at 503-659-1994. The NPI was assigned on December 20, 2006 and the record was last updated in NPPES on July 9, 2007.
●Provider Profile Details
- NPI Number
- 1902960362
- Provider Name
- Jack R Agen
- Credential
- MA
- Entity Type
- Individual (Type 1 NPI)
- Gender
- Male
- Primary Taxonomy
- Counselor, Professional · 101YP2500X
- Sole Proprietor
- No
- Enumeration Date
- December 20, 2006
- Last Update Date
- July 9, 2007
- NPI Status
- Active
◉Business Practice Location Address
- Address
- 880 82ND Dr
Gladstone, OR 97027-1803 - City
- Gladstone
- State
- Oregon
- ZIP
- 97027-1803
- Country
- US
- Phone Number
- 503-659-5515
- Fax Number
- 503-659-1994
✉Business Mailing Address
- 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
✎Taxonomy & License Information
| Taxonomy | Code | Primary | License | State |
|---|---|---|---|---|
| Counselor, Professional | 101YP2500X | Yes | C1077 | OR |
#Other Provider Identifiers
No legacy or other identifiers (Medicaid, Medicare or plan IDs) are on file for this provider.
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View all 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) and holds license No. C1077 (OR).
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 at npiregistry.cms.hhs.gov.