Individual
JENNIFER ROSE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
39420 SE GORDON CREEK RD, CORBETT, OR 97019-8750
(503) 695-2977
Mailing address
4536 NE 30TH AVE, PORTLAND, OR 97211-7136
(503) 347-3380
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC189963
OR
225700000X
Massage Therapist
20187
OR
Other
Enumeration date
01/30/2019
Last updated
01/30/2019
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