Individual
JOANNA L MCCLISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LMT
Contact information
Practice address
5112 NE GLISAN ST, PORTLAND, OR 97213-2940
(503) 309-1333
Mailing address
2000 NE 42ND AVE, #209, PORTLAND, OR 97213-1399
(503) 309-1333
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT-AT-10141269
OR
225700000X
Massage Therapist
Primary
11778
OR
Other
Enumeration date
04/26/2006
Last updated
10/22/2012
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