Provider Demographics
NPI:1902479256
Name:ZENN, ANDREA (LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ZENN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:ZENN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97011-0094
Mailing Address - Country:US
Mailing Address - Phone:503-308-8238
Mailing Address - Fax:
Practice Address - Street 1:5305 RIVER RD N STE B
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:503-308-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional