Individual
JENNIFER RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC-II, CIP, CAI-II
Contact information
Practice address
10600 SE MCLOUGHLIN BLVD STE 207, MILWAUKIE, OR 97222-7428
(855) 770-0577
(503) 654-1852
Mailing address
10600 SE MCLOUGHLIN BLVD STE 207, MILWAUKIE, OR 97222-7428
(855) 770-0577
(503) 654-1852
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Enumeration date
05/24/2019
Last updated
05/24/2019
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