Provider Demographics
NPI:1447482385
Name:HAUNOLD, JENNIFER RHAE (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RHAE
Last Name:HAUNOLD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RHAE
Other - Last Name:WANGERIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1815 SW MARLOW
Mailing Address - Street 2:STE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5185
Mailing Address - Country:US
Mailing Address - Phone:503-292-0765
Mailing Address - Fax:503-292-5208
Practice Address - Street 1:1815 SW MARLOW
Practice Address - Street 2:STE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5185
Practice Address - Country:US
Practice Address - Phone:503-292-0765
Practice Address - Fax:503-292-5208
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist