Provider Demographics
NPI:1851661599
Name:WOHL, JENNIFER BARD (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BARD
Last Name:WOHL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NW 21ST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1174
Mailing Address - Country:US
Mailing Address - Phone:503-964-8445
Mailing Address - Fax:
Practice Address - Street 1:325 NW 21ST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1174
Practice Address - Country:US
Practice Address - Phone:503-964-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional