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Individual

IVANA ANTO JUNGIC

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3807 NE MLK BLVD, PORTLAND, OR 97212-1114
(503) 816-6576
Mailing address
3807 NE MLK BLVD, PORTLAND, OR 97212-1114

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
THW000002092
OR
Enumeration date
05/01/2018
Last updated
05/01/2018
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