Individual
DONALD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9138 NE HOYT ST, PORTLAND, OR 97220-5868
(206) 249-6133
Mailing address
9138 NE HOYT ST, PORTLAND, OR 97220-5868
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
R8539
OR
Other
Enumeration date
09/11/2023
Last updated
09/19/2023
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