Individual
STEVEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
2701 NW VAUGHN ST, PORTLAND, OR 97210-5311
(503) 499-5200
Mailing address
2701 NW VAUGHN ST, PORTLAND, OR 97210-5311
(503) 499-5200
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1779
OR
104100000X
Social Worker
60135320
WA
Other
Enumeration date
12/16/2011
Last updated
12/16/2011
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