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General NPI Number Information
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NPI Number | 1851661599
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Entity Type | Individual
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Provider Name | JENNIFER BARD WOHL M.A., L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 325 NW 21ST AVE SUITE 101
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City | PORTLAND
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State | OR
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Zip | 97209-1174
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Country | US
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Telephone | 503-964-8445
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Fax |
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Provider Business Mailing Address
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Address Line | 325 NW 21ST AVE SUITE 101
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City | PORTLAND
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State | OR
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Zip | 97209-1174
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Country | US
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Telephone | 503-964-8445
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C2798
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License Number State | OR
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