Individual
MONICA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
134 SE 5TH AVE, SUITE C, HILLSBORO, OR 97123-4095
(971) 777-0756
(503) 648-5269
Mailing address
134 SE 5TH AVE, SUITE C, HILLSBORO, OR 97123-4095
(971) 777-0756
(503) 648-5269
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278095
—
OR
Enumeration date
10/18/2016
Last updated
10/18/2016
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