Individual
JENNIFER M SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
501 N GRAHAM ST STE 100, PORTLAND, OR 97227-1650
(503) 249-5780
(503) 249-5788
Mailing address
1411 SW MORRISON ST STE 200, PORTLAND, OR 97205-1945
(503) 242-9850
(503) 279-8157
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD27695
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
IN PROCESS
OR
Enumeration date
08/07/2007
Last updated
07/24/2024
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