Individual
JACOB RYAN STEWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
377 LACLAIR ST, COOS BAY, OR 97420-4709
(541) 756-2057
Mailing address
PO BOX 1013, NORTH BEND, OR 97459-0077
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
111202
OR
Other
Enumeration date
06/20/2024
Last updated
06/20/2024
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