Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 10411871 | OR |
NPI | 1063828259 |
---|---|
Provider Name | Dr. Sue Maria Menen Jessing |
First Address | Eugene, OR 97404-1601 |
Second Address | Eugene, OR 97404-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 08/07/2014 |