Individual
JENNIFER LYNN WIDDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6396 SW MCVEY AVE, REDMOND, OR 97756-9069
(541) 389-1858
Mailing address
22350 CALGARY DR, BEND, OR 97702-9216
(541) 749-8895
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
112910
OR
Other
Enumeration date
12/31/2024
Last updated
12/31/2024
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