Individual
JULIE D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
(503) 235-8655
Mailing address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22-09-10526
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-09-10526
OREGON MHACBO
OR
Enumeration date
09/21/2022
Last updated
09/21/2022
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