Individual
JENSINE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
Mailing address
4730 SE BELMONT ST APT 3, PORTLAND, OR 97215-1772
(608) 469-8605
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L11844
OR
Other
Enumeration date
01/10/2025
Last updated
01/10/2025
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