Organization
LAKE GROVE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEEN JORDAN LMT (OWNER)
(503) 908-1180
Entity
Organization
Contact information
Practice address
16320 BRYANT RD, LAKE OSWEGO, OR 97035-4308
(503) 908-1180
Mailing address
16320 BRYANT RD, LAKE OSWEGO, OR 97035-4308
(503) 908-1180
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6748
OR
Other
Enumeration date
06/02/2014
Last updated
06/02/2014
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