Individual
MISS JENNIFER CHRISTINA LISK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW; CADC-R
Contact information
Practice address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 204-2704
Mailing address
1 SERENITY LN, COBURG, OR 97408-9350
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Enumeration date
04/08/2018
Last updated
02/27/2024
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