Individual
JODIE JAN BAGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
712 SE HAWTHORNE BLVD STE 100, PORTLAND, OR 97214-3538
(503) 913-5733
(503) 327-8005
Mailing address
712 SE HAWTHORNE BLVD STE 100, PORTLAND, OR 97214-3538
(503) 913-5733
(503) 327-8005
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
R-1935
OR
Other
Enumeration date
11/10/2011
Last updated
08/19/2014
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