Individual
JACQUELYN FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
413 TEAKWOOD DR, EAGLE POINT, OR 97524-6608
(337) 509-8607
Mailing address
413 TEAKWOOD DR, EAGLE POINT, OR 97524-6608
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
Primary
A14436
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/07/2017
Last updated
04/17/2024
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