Individual
JESSICA MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
18670 WILLAMETTE DR, SUITE 102, WEST LINN, OR 97068-1796
(503) 635-4888
Mailing address
18670 WILLAMETTE DR, SUITE 102, WEST LINN, OR 97068-1796
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC156733
OR
Other
Enumeration date
07/03/2012
Last updated
07/03/2012
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