Individual
JENNY DIANE REEVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1840 SE 106TH AVE, PORTLAND, OR 97216-2936
(971) 322-8209
Mailing address
1840 SE 106TH AVE, PORTLAND, OR 97216-2936
(971) 322-8208
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11298
OR
Other
Enumeration date
06/19/2014
Last updated
06/19/2014
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