Individual
MS. JENNIFER MARIE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
200 HAWTHORNE AVE SE, SALEM, OR 97301-5860
(971) 599-0793
Mailing address
1598 ALDER DR NE, KEIZER, OR 97303-4018
(971) 599-0793
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
L8286
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104232586
—
OR
Enumeration date
07/07/2014
Last updated
05/28/2022
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