Individual
LASHAUNDA LOUISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
509 NE ALBERTA ST, PORTLAND, OR 97211-3976
(503) 249-7767
Mailing address
12942 SE MITCHELL ST, PORTLAND, OR 97236-4151
(503) 754-3088
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/02/2007
Last updated
12/14/2009
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