Individual
JENELLE LYNN DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LE
Contact information
Practice address
2942 FENYA ST, SPRINGFIELD, OR 97477-7945
(541) 810-0884
Mailing address
2942 FENYA ST, SPRINGFIELD, OR 97477-7945
(541) 810-0884
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10254980
OR
Other
Enumeration date
03/18/2021
Last updated
07/12/2025
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