Individual
DR. CONSTANCE JANENE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4800 SW MACADAM AVE, SUITE 350, PORTLAND, OR 97239-3925
(503) 297-6656
(503) 297-5779
Mailing address
3439 NE SANDY BLVD, PMB 375, PORTLAND, OR 97232-1959
(503) 284-8841
(503) 282-3302
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD18409
OR
Other
Enumeration date
10/12/2006
Last updated
11/04/2011
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