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General NPI Number Information
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NPI Number | 1154110468
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Entity Type | Individual
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Provider Name | JENNA MARIE BEAN
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Gender | Female
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1010 11TH AVE SW
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City | ALBANY
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State | OR
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Zip | 97321-2019
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Country | US
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Telephone | 541-248-7810
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 11TH AVE SW
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City | ALBANY
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State | OR
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Zip | 97321-2019
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Country | US
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Telephone | 541-990-9143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 22-CRM-1559
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T-25-5306
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License Number State | OR
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