Individual
DR. JACLYN RENEE DEROSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD.
Contact information
Practice address
18040 SHERMAN WAY, RESEDA, CA 91335-4631
(503) 997-4669
Mailing address
5309 SW MULTNOMAH BLVD, PORTLAND, OR 97219-3345
(541) 979-2344
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
30928
OR
Other
Enumeration date
04/04/2019
Last updated
10/13/2020
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