Most Relevant Information
Provider Data
| NPI Number: | 1003308917 |
| Provider Name: | JEREMY GORDON ALLEN |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/06/2018 |
| Last Updated: | 10/02/2018 |
Provider Practice Location
2555 SILVERTON RD NE
SALEM
OR
973010837
Practice Location Phone/Fax
| Phone: | 9712832776 |
| Fax: |
Provider Mailing Location
1115 MADISON ST NE # 222
SALEM
OR
973017862
Provider Mailing Phone/Fax
| Phone: | 9712832776 |
| Fax: |