Individual
MARY JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1250 BASELINE, CORNELIUS, OR 97113
(503) 357-3821
(503) 357-9090
Mailing address
1250 BASELINE, CORNELIUS, OR 97113
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17359
OR
Other
Enumeration date
08/19/2011
Last updated
08/19/2011
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