Individual
JONATHAN ALEXANDER VASHCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4160 NE SANDY BLVD # 1100, PORTLAND, OR 97212-5336
(503) 249-9000
Mailing address
151 E LINCOLN ST, WOODBURN, OR 97071-5023
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18565
OR
Other
Enumeration date
08/06/2018
Last updated
08/06/2018
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