Individual
ANDREA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
33 NE KELLY AVE, GRESHAM, OR 97030-7539
(503) 545-2393
Mailing address
2005 SE 159TH PL, VANCOUVER, WA 98683-4406
(503) 545-2393
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01036
OR
Other
Enumeration date
02/14/2007
Last updated
07/08/2011
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