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Individual

JASMINE PETTET

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CADC1

Contact information

Practice address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 793-7389
Mailing address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 793-7389

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
130942
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1568401347
OR
Enumeration date
09/30/2014
Last updated
09/30/2014
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