Individual
LYDIA MICHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3136 SE 136TH AVE, PORTLAND, OR 97236-2800
(971) 895-5485
Mailing address
3136 SE 136TH AVE, PORTLAND, OR 97236-2800
(971) 895-5485
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
111668
OR
Other
Enumeration date
10/21/2024
Last updated
10/21/2024
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