Individual
JENNIFER MARIE BOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
24850 SE STARK ST, SUITE 200, GRESHAM, OR 97030-8316
(503) 310-2622
Mailing address
24850 SE STARK ST, SUITE 200, GRESHAM, OR 97030-8316
(503) 310-2622
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7615
OR
Other
Enumeration date
03/21/2007
Last updated
11/09/2016
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