Individual
JOHN JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC II
Contact information
Practice address
2415 SE 43RD AVE, PORTLAND, OR 97206-1600
(503) 230-9654
Mailing address
2425 SW 171ST PL, BEAVERTON, OR 97006-4300
(415) 309-4500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11-R-10
OR
Other
Enumeration date
05/30/2007
Last updated
05/31/2011
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