Individual
JESSIE KULLBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1944 SHERMAN AVE STE 201, NORTH BEND, OR 97459-3478
(541) 260-6098
Mailing address
PO BOX 1316, NORTH BEND, OR 97459-0088
(541) 260-6098
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L5271
OR
Other
Enumeration date
03/12/2012
Last updated
07/26/2013
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