Individual
MELISSA T JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS HUMAN SERVICES
Contact information
Practice address
11035 NE SANDY BLVD, PORTLAND, OR 97220-2553
(503) 736-6699
(503) 256-9601
Mailing address
11035 NE SANDY BLVD, PORTLAND, OR 97220-2553
(503) 736-6699
(503) 256-9601
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
12/11/2012
Last updated
05/02/2019
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