Provider Demographics
NPI:1447304985
Name:BRISSENDEN, JENNIFER LYNN (QMHA, CADC I)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:BRISSENDEN
Suffix:
Gender:F
Credentials:QMHA, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6895 SW LARKSPUR PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5131
Mailing Address - Country:US
Mailing Address - Phone:503-430-0822
Mailing Address - Fax:
Practice Address - Street 1:400 E MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4163
Practice Address - Country:US
Practice Address - Phone:503-640-9892
Practice Address - Fax:503-648-9732
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)