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Individual

JERRY KORKOW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSS

Contact information

Practice address
280 NE SANTIAM BLVD, MILL CITY, OR 97360
(971) 332-5676
Mailing address
614 W CENTRAL AVE, GATES, OR 97346-9307

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000107518
OR

Other

Enumeration date
11/22/2022
Last updated
11/22/2022
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