Individual
DESIRE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8975 SW SWEEK DR APT 222, TUALATIN, OR 97062-7481
(503) 544-2020
Mailing address
8975 SW SWEEK DR APT 222, TUALATIN, OR 97062-7481
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20590
OR
Other
Enumeration date
08/09/2015
Last updated
08/09/2015
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