Individual
JILL/ ELLEN CONRAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.M.F.T
Contact information
Practice address
1300 BROADWAY ST. NE, STE # 409, SALEM, OR 97301-9730
(503) 370-8050
Mailing address
1300 BROADWAY STREET NE SUITE #409, SALEM, OR 97301
(503) 370-8050
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
T0731
OR
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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