Individual
JEANETTE MARIE FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
2375 NW GLISAN ST, PORTLAND, OR 97210-3420
(503) 243-2236
(503) 243-2429
Mailing address
9515 SE 74TH AVE, PORTLAND, OR 97222-1817
(503) 708-9256
(503) 243-2429
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/01/2007
Last updated
09/11/2025
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