Individual
JADE MANISCALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7003 SE WOODSTOCK BLVD, PORTLAND, OR 97206-5940
(503) 719-4776
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
09/22/2014
Last updated
10/28/2014
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