Provider Demographics
NPI:1740648252
Name:MOWRY, JENNIFER (AAS, CADC I)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MOWRY
Suffix:
Gender:F
Credentials:AAS, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12950 SW PACIFIC HWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5061
Mailing Address - Country:US
Mailing Address - Phone:503-624-9545
Mailing Address - Fax:503-684-0778
Practice Address - Street 1:12950 SW PACIFIC HWY
Practice Address - Street 2:SUITE 235
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5061
Practice Address - Country:US
Practice Address - Phone:503-624-9545
Practice Address - Fax:503-684-0778
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13/12-29101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)