Individual
LYDIA MICHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 N VANCOUVER AVE, PORTLAND, OR 97227-1630
(503) 413-4500
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
111668
OR
Other
Enumeration date
10/21/2024
Last updated
07/03/2026
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