Individual
MR. JACK OPGENORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
1744 E MCANDREWS RD, SUITE B, MEDFORD, OR 97504
(541) 776-0821
(541) 776-5011
Mailing address
1744 E MCANDREWS RD, SUITE B, MEDFORD, OR 97504
(541) 776-0821
(541) 776-5011
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2954
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L2954
LICENSE NUMBER
OR
Enumeration date
02/26/2007
Last updated
02/11/2016
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