Individual
MARY JANE HAAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPCP
Contact information
Practice address
1017 SW MORRISON ST, 205, PORTLAND, OR 97205-2635
(503) 224-8416
(503) 973-5433
Mailing address
1017 SW MORRISON ST, 205, PORTLAND, OR 97205-2635
(503) 224-8416
(503) 973-5433
Taxonomy
Speciality
Code
Description
License number
State
246ZA2600X
Medical Art Specialist/Technologist
Primary
EPT-T-652245
OR
Other
Enumeration date
12/22/2011
Last updated
12/22/2011
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