Provider Demographics
NPI:1578080289
Name:WELTON, JENNIFER RICHARDS (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RICHARDS
Last Name:WELTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-1441
Mailing Address - Country:US
Mailing Address - Phone:406-581-5830
Mailing Address - Fax:
Practice Address - Street 1:260 SW MADISON AVE STE 119-1
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4798
Practice Address - Country:US
Practice Address - Phone:406-581-5830
Practice Address - Fax:406-581-5830
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL82351041C0700X
MTBBH-LCSW-LIC-190381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical