Provider Demographics
NPI:1992680177
Name:MOORE, JILLIAN MARGUERITE (CRM)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARGUERITE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 W MADRONA AVE APT B
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1445
Mailing Address - Country:US
Mailing Address - Phone:541-314-5570
Mailing Address - Fax:
Practice Address - Street 1:200 SE HAILEY AVE STE 204
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3072
Practice Address - Country:US
Practice Address - Phone:541-663-4104
Practice Address - Fax:541-663-4142
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-CRM-4289251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health