Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003274895 |
---|---|
Provider Name | Jessica Krieger |
First Address | Lebanon, OR 97355-2868 |
Second Address | Lebanon, OR 97355-2868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2016 |
Last Update Date | 17/09/2018 |