Individual
JENNA BLACKHURST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
11415 SW SCHOLLS FERRY RD, BEAVERTON, OR 97008-7168
(541) 261-6482
Mailing address
10914 SW 111TH AVE, TIGARD, OR 97223-3611
(541) 261-6482
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22171
OR
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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