Individual
JAKE PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
2236 SE BELMONT ST, PORTLAND, OR 97214-2817
(503) 445-7699
Mailing address
2236 SE BELMONT ST, PORTLAND, OR 97214-2817
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
110012
OR
Other
Enumeration date
11/09/2023
Last updated
11/09/2023
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