Individual
JILLIAN LUCILLE INGOGLIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
5308 SE RHONE ST, PORTLAND, OR 97206-2962
(503) 775-6885
Mailing address
4126 N COMMERCIAL AVE, PORTLAND, OR 97217-3026
(516) 455-4225
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
19758
OR
Other
Enumeration date
07/31/2013
Last updated
07/31/2013
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