MEDICARE: JENNIFER MOWRY AAS, CADC I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13/12-29	OR

General Provider Information

NPI Number	:	1740648252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MOWRY AAS, CADC I

Provider Business Mailing Address
First Line	:	12950 SW PACIFIC HWY
Second Line	:	SUITE 235
City	:	TIGARD
State	:	OR
Zip	:	97223-5061
Country	:	US
Telephone Number	:	503-624-9545
Fax Number	:	503-684-0778

Provider Business Practice Location Address
First Line	:	12950 SW PACIFIC HWY
Second Line	:	SUITE 235
City	:	TIGARD
State	:	OR
Zip	:	97223-5061
Country	:	US
Telephone Number	:	503-624-9545
Fax Number	:	503-684-0778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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