Individual
KELLY LYNN JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2304 E BURNSIDE ST STE 1, PORTLAND, OR 97214-1677
(971) 716-2447
Mailing address
2304 E BURNSIDE ST STE 1, PORTLAND, OR 97214-1677
(971) 716-2447
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25964
OR
Other
Enumeration date
03/03/2021
Last updated
03/03/2021
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