Individual
JENNAFER ROSE DEIDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FAMILY PEER SUPPORT
Contact information
Practice address
700 S J ST, LAKEVIEW, OR 97630-1623
(541) 947-6021
Mailing address
700 S J ST, LAKEVIEW, OR 97630-1623
(541) 947-6021
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
23-QMHA-R-3371
OR
175T00000X
Peer Specialist
107865
OR
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/22/2022
Last updated
03/13/2023
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