Individual
ANGELA RAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1820 SW VERMONT ST, STE E, PORTLAND, OR 97219-1945
(971) 266-3410
Mailing address
1820 SW VERMONT ST, STE E, PORTLAND, OR 97219-1945
(971) 266-3410
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC178054
OR
Other
Enumeration date
04/15/2017
Last updated
04/15/2017
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