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Individual

JESSEKA JEAN COLLINS I

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
14741 SW 109TH AVENUE APT 3, TIGARD, OR 97224
(541) 786-8107
Mailing address
14741 SW 109TH AVE APT 3, TIGARD, OR 97224-3211
(541) 786-8107

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22091
OR

Other

Enumeration date
06/07/2016
Last updated
06/07/2016
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