Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1660 | OR |
NPI | 1104140391 |
---|---|
Provider Name | Dr. Jennifer Renee Carroll |
First Address | Lake Oswego, OR 97035-7775 |
Second Address | Lake Oswego, OR 97035-7775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2010 |
Last Update Date | 23/03/2021 |