Individual
JESSICA DE CLERCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 SW 18TH AVE, PORTLAND, OR 97205-1711
(971) 238-4789
Mailing address
1525 SE 44TH AVE APT 403, PORTLAND, OR 97215-3176
(971) 386-3195
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/18/2024
Last updated
06/18/2024
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