| NPI | 1164843470 |
|---|---|
| Former Name | JESSICA REANNE BONACKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 22-II-20220) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000002914) |
| 172V00000X Community Health Worker (Licence: OR THW000002914) | |
| 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHA-II-000058) | |
| Enumeration Date | 2014-01-04 |
| Last Update Date | 2024-03-05 |