Individual
JERRY DALE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1535 N WILLIAMS AVE, PORTLAND, OR 97227-1885
(503) 238-2003
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
(503) 294-4321
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW105547
OR
Other
Enumeration date
07/18/2022
Last updated
07/18/2022
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