| NPI | 1376810838 |
|---|---|
| Former Name | JESSICA LYNN NEELY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 09-P-04) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2011-11-28 |