Individual
JENNIFER A BLECKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
847 NE 19TH AVE, PORTLAND, OR 97232-2684
(503) 238-0705
Mailing address
847 NE 19TH AVE, PORTLAND, OR 97232-2684
(503) 238-0705
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/04/2008
Last updated
09/29/2010
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