Individual provider · Type 1 NPI

Jack R. Agen, MA

Professional Counselor · Gladstone, OR

NPI number 1902960362 Active

Practice location

880 82nd Dr
Gladstone, OR 97027-1803

Call (503) 659-5515 Map

Fax (503) 659-1994

Mailing address

PO Box 82819
Portland, OR 97282-0819

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500XC1077 (OR)

Professional Counselor: Definition to come...

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About NPI 1902960362

Jack R. Agen, MA's National Provider Identifier is 1902960362, issued on Dec 20, 2006. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Gladstone, OR. The record was last updated on Jul 9, 2007.