Individual
BRYANNA MARIE JELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP
Contact information
Practice address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
(360) 423-5128
Mailing address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
(360) 423-5128
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60279397
WA
Other
Enumeration date
01/07/2019
Last updated
04/21/2021
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