Individual
FATIMA JALLOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3005 NE DIAMOND LAKE BLVD, ROSEBURG, OR 97470-3609
(541) 440-3532
(541) 440-3554
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 440-3532
(541) 440-3554
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1041C0700X
OR
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L11796
OR
Other
Enumeration date
09/04/2020
Last updated
09/23/2024
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