Individual
MICHAEL DAVID JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1605 E LINCOLN RD, WOODBURN, OR 97071-5137
(503) 982-9300
Mailing address
2045 SILVERTON RD NE, SALEM, OR 97301-0100
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201401353RN
OR
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
201401353RN
OR
Other
Enumeration date
11/28/2018
Last updated
01/08/2025
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