Individual
MS. JEANINE GLADYS PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
328 3RD ST SW, WILLMAR, MN 56201-3475
(320) 231-9763
(320) 235-0334
Mailing address
328 3RD ST SW, WILLMAR, MN 56201-3475
(320) 231-9763
(320) 235-0334
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301951
MN
Other
Enumeration date
02/05/2013
Last updated
02/05/2013
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