Individual
JOLYNN MARIE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
421 SW OAK ST, PORTLAND, OR 97204-1817
(503) 988-5464
(503) 988-5870
Mailing address
421 SW OAK ST, PORTLAND, OR 97204-1817
(503) 988-5464
(503) 988-5870
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
171M0000X
OR
Other
Enumeration date
11/28/2012
Last updated
11/28/2012
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