Individual
TYLER ALANA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 E HISTORIC COLUMBIA RIVER HWY, TROUTDALE, OR 97060-2006
(971) 293-9237
Mailing address
121 E HISTORIC COLUMBIA RIVER HWY, TROUTDALE, OR 97060-2006
(214) 934-4344
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
J25080199625
IL
Other
Enumeration date
07/23/2024
Last updated
07/23/2024
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