Individual
TAILESE SWANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
NTP
Contact information
Practice address
PO BOX 1228, JACKSONVILLE, OR 97530-1228
(541) 621-2312
Mailing address
PO BOX 1228, JACKSONVILLE, OR 97530-1228
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
10/13/2025
Last updated
10/13/2025
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