Individual
MR. JESSIE JEROME ISAAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MST, RC
Contact information
Practice address
7511 SE HENRY ST, PORTLAND, OR 97206-6445
(503) 771-6061
Mailing address
3608 SE 40TH AVE APT 3, PORTLAND, OR 97202-1769
(503) 493-9723
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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