Individual
JACQUELINE PETROVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 NE DIVISION ST STE 201, BEND, OR 97701-3572
(541) 516-6330
Mailing address
1900 NE DIVISION ST STE 201, BEND, OR 97701-3572
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/07/2021
Last updated
04/28/2023
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