Individual
KAITLYN JUNGBLUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10822 SE 82ND AVE, HAPPY VALLEY, OR 97086
(503) 239-8400
Mailing address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YA0400X
OR
Other
Enumeration date
06/29/2018
Last updated
06/29/2018
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