Individual
JESSICA L BRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2233 W HARVARD AVE, ROSEBURG, OR 97471-2550
(541) 670-2264
Mailing address
PO BOX 1756, ROSEBURG, OR 97470-0420
(541) 670-2264
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C3280
OR
Other
Enumeration date
09/21/2011
Last updated
10/19/2022
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