Individual
JAKE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1235 SE MORRISON ST, PORTLAND, OR 97214-2462
(503) 746-3373
Mailing address
7346 NE SANDY BLVD, PORTLAND, OR 97213-5775
(503) 746-3373
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/20/2024
Last updated
09/20/2024
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