Provider Demographics
NPI:1285373282
Name:FLANNERY, JENNA (LPC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 NW 7TH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1729
Mailing Address - Country:US
Mailing Address - Phone:805-300-2956
Mailing Address - Fax:
Practice Address - Street 1:2445 NE DIVISION ST STE 200&204
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3571
Practice Address - Country:US
Practice Address - Phone:541-229-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC8629OtherLPC #