Individual
JESSICA MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
419 E 7TH ST, THE DALLES, OR 97058-2676
(541) 296-5452
Mailing address
419 E 7TH ST, THE DALLES, OR 97058-2676
(541) 296-5452
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
104100000X
OR
Other
Enumeration date
04/28/2015
Last updated
10/24/2017
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