Individual
JACLYN THIESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
OREGON HEALTH AND SCIENCE UNIVERSITY, 3181 SAM JACKSON PK RD., L340, PORTLAND, OR 97239
(503) 494-9000
Mailing address
OREGON HEALTH AND SCIENCE UNIVERSITY, 3181 SAM JACKSON PARK RD. L340, PORTLAND, OR 97239
(503) 494-9000
Taxonomy
Speciality
Code
Description
License number
State
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
MD198169
OR
2085R0202X
Diagnostic Radiology Physician
Primary
MD198169
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2014
Last updated
05/12/2020
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