Individual
JARED UTTERBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
695 SW MILL VIEW WAY STE 207, BEND, OR 97702-1557
(458) 202-9632
Mailing address
61181 LODGEPOLE DR, BEND, OR 97702-2880
(458) 202-9632
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
R5529
OR
106H00000X
Marriage & Family Therapist
Primary
T1907
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500767552
—
OR
Enumeration date
05/22/2019
Last updated
04/03/2023
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