JENNIFER KAY BLAKE MA
NPI 1972620110
Counselor in Eugene, OR

Q: What is Jennifer Blake's NPI number?

The NPI number for Jennifer Blake is 1972620110. It was assigned to this individual provider in the NPPES registry on March 23, 2007.

Q: What is Jennifer Blake's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Q: Is Jennifer Blake enrolled in Medicare?

No. Jennifer Blake has opted out of Medicare through January 15, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Jennifer Blake was last updated on May 28, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 23, 2007Opted out of Medicare · through Jan 15, 2027

150 SHELTON MCMURPHEY BLVD STE 101, EUGENE, OR 97401(541) 210-8090(541) 210-5310 Get Directions Write a Review

NPPES record last updated: May 28, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 28, 2020, May 21, 2020 (2 updates tracked since 2020).

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About Jennifer Kay Blake Ma NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNIFER KAY BLAKE MA (NPI 1972620110) is an individual counselor in Eugene, Oregon and active in the NPI registry since March 2007. She has opted out of Medicare through January 15, 2027 and maintains a secondary practice location in Springfield.

NPPES Registry Identity

NPI1972620110

Entity TypeIndividualFemale

Primary Taxonomy101Y00000X

Provider Legal NameJENNIFER KAY BLAKECredential: MA

Location Address150 SHELTON MCMURPHEY BLVD STE 101Eugene, OR 97401-5015

Mailing Address3995 Marcola RdSpringfield, OR 97477-7948 · (541) 726-1465 · Fax (541) 726-5085

Phone(541) 210-8090

Fax(541) 210-5310

Sole ProprietorNo

Enumeration DateMarch 23, 2007

Last NPPES UpdateMay 28, 20202 updates tracked since enumeration

NPPES CertifiedMay 28, 2020

✔ NPI 1972620110 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License C5663 (OR)

150 SHELTON MCMURPHEY BLVD STE 101, Eugene, OR 97401

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Secondary Practice Location 1

Location 13995 Marcola RdSpringfield, OR 97477-7948 · Phone (541) 726-1465 · Fax (541) 726-5085

Other Identifiers 2

Other1972620110OR · Npi

Medicaid500663059OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Jennifer Kay Blake Ma has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 15, 2025 through January 15, 2027.

Opt-Out Effective DateJanuary 15, 2025

Opt-Out In Effect ThroughJanuary 15, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. NICHOLE RENEE RAYMOND QMHP

Counselor (Mental Health)