Provider Demographics
NPI:1972878338
Name:LI, JENNA LEANN (LPC, CADC I)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LEANN
Last Name:LI
Suffix:
Gender:F
Credentials:LPC, CADC I
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEANN
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CADC I
Mailing Address - Street 1:212 ARLENE AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4939
Mailing Address - Country:US
Mailing Address - Phone:541-948-7054
Mailing Address - Fax:
Practice Address - Street 1:2651 COMMERCIAL ST SE STE 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4872
Practice Address - Country:US
Practice Address - Phone:503-587-9937
Practice Address - Fax:503-994-8049
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR3309101Y00000X
OR13-12-23101YA0400X
ORC4589101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)