Individual
JESSICA GLISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
107 SE WASHINGTON ST, SUITE#134, PORTLAND, OR 97214-2103
(503) 236-6633
Mailing address
1426 SE 25TH AVE, APT 5, PORTLAND, OR 97214-3966
(503) 348-9774
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18512
OR
Other
Enumeration date
06/12/2012
Last updated
07/09/2012
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