Individual
JACQUELYN BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
118 N KILLINGSWORTH ST, PORTLAND, OR 97217-2435
(503) 288-4454
Mailing address
11445 SE 31ST AVE, MILWAUKIE, OR 97222-6715
14025253433
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23191
OR
Other
Enumeration date
07/18/2017
Last updated
07/18/2017
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