JENNIFER LUSTBADER (NPI# 1639555600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639555600 |
| Entity Type | Individual |
| Full Name | JENNIFER LUSTBADER |
| Credential | CMR |
| Practice Address |
14760 Sw Forest Dr Beaverton OR 97007-5117 |
| Practice Telephone | 5038607481 |
| Mailing Telephone | 5038607481 |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2015-07-31 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 15-CRM-111 | OR | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | UNDETERMINED | 15-CRM-111 | 01 |
| Street Address |
14760 SW FOREST DR |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97007-5117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891272225 | Ben Shepherd Cohn | Massage Therapist | 16088 Sw Hillary Pl, Beaverton, OR 97007 | 2018-07-27 |
| 1013410455 | Taryn Weslie Van Vliet | Counselor | Forward Stride, 23839 Sw Daniel Rd., Beaverton, OR 97007 | 2018-03-12 |
| 1588181184 | Sarah Rennalls | Massage Therapist | 16315 Sw Barrows Road #203, Beaverton, OR 97007 | 2017-08-24 |
| 1982137501 | Patrick N Huynh | Nurse Practitioner | 14795 Sw Scholls Dr., Beaverton, OR 97007 | 2017-04-10 |
| 1841675428 | Jessica C Moore | Social Worker | 4585 Sw185th Ave, Beaverton, OR 97007 | 2015-07-24 |
| 1205233913 | Julie Guzman | Case Manager/Care Coordinator | 4585 Sw 185th Ave., Beaverton, OR 97007 | 2014-11-24 |
| 1255738183 | Jennifer Kenedy | Case Manager/Care Coordinator | 4585 Sw 185th Avenue, Aloha, OR 97007 | 2014-11-20 |
| 1053754069 | Dr Bob Health Centre | Internal Medicine | 16325 Sw Sexton Mountain Dr, Beaverton, OR 97007 | 2013-04-09 |
| 1518211713 | Rosebelinda S Nelson | Dental Hygienist | 3895 Sw 18th Ave. #170, Aloha, OR 97007 | 2012-11-09 |
| 1073871240 | Suzanne Mcreynolds | Mechanotherapist | 16784 Sw Vincent St, Beaverton, OR 97007 | 2012-04-25 |
| Find all providers in zip 97007 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093206757 | Sarah K Hertz | Peer Specialist | 6275 Sw Mad Hatter Ln, Beaverton, OR 97008-8509 | 2018-05-29 |
| 1578160859 | Rene Hadley | Peer Specialist | 3800 Sw Cedar Hills Blvd, Beaverton, OR 97005-2027 | 2020-10-08 |
| 1760091839 | Peggy Lynn Humphries | Peer Specialist | 10700 Sw Beaverton Hillsdale Hwy Bldg 1, Beaverton, OR 97005-3019 | 2020-07-24 |
| 1568095339 | Shawn Kevin Hudson | Peer Specialist | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-02-19 |
| 1093359291 | Lujein Solaiman Alkreidi | Peer Specialist | 3800 Sw Cedar Hills Blvd Ste 288, Beaverton, OR 97005-2035 | 2019-10-30 |
| 1205477783 | Carlos Thomas Benson Martinez | Peer Specialist | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2019-10-04 |
| 1871134353 | Bianca Maldonado Ramirez | Peer Specialist | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2019-10-04 |
| 1487101648 | Juliana Clark | Peer Specialist | 10700 Sw Beaverton Hillsdale Hwy, Beaverton, OR 97005-3019 | 2016-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1578162145 | Kenneth Branson | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-10-23 |
| 1962000554 | Dawn Marks | Peer Specialist | 21440 Se Stark St, Gresham, OR 97030-2024 | 2020-10-15 |
| 1679188080 | Michelle Marie Bunkers | Peer Specialist | 20517 Jacklight Ln, Bend, OR 97702-2971 | 2020-09-11 |
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1528677820 | Charice Monette | Peer Specialist | 4151 Kacey Cir Ne, Salem, OR 97305-4504 | 2020-07-23 |
| 1841810322 | Ariana Lee May | Peer Specialist | 1601 Olive St Apt 1008, Eugene, OR 97401-3985 | 2020-04-24 |
| 1982237236 | Jessica M Montoya | Peer Specialist | 235 Se Knowledge St, Prineville, OR 97754-2362 | 2020-02-14 |
| 1134752579 | Lisa Kennedy | Peer Specialist | 132 Ne B St # 24, Grants Pass, OR 97526-2114 | 2020-02-13 |
| 1730711953 | Michael Anthony Duran | Peer Specialist | 1515 Hill St Se, Albany, OR 97322-6715 | 2020-02-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.