Individual
TABITHA LEEANN JENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2410 SE 121ST AVE, #216, PORTLAND, OR 97216-4066
(503) 335-5975
Mailing address
1544 SE 27TH CT, TROUTDALE, OR 97060-2409
(971) 235-8141
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/01/2010
Last updated
09/01/2010
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