Individual
JENNIFER B BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
71840 MEADOW LOOP, BOARDMAN, OR 97818-9668
(541) 303-4658
Mailing address
PO BOX 245, BOARDMAN, OR 97818-0245
(541) 303-4658
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000004247
OR
Other
Enumeration date
05/03/2022
Last updated
05/03/2022
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