| NPI | 1720110232 |
|---|---|
| Former Name | MARI ELIZABETH JENSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR OR 97-04-75) |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2007-07-13 |