Individual
JENNIFER JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1201 SW 12TH AVE, SUITE 600, PORTLAND, OR 97205
(503) 224-2425
(503) 224-7512
Mailing address
1201 SW 12TH AVE, SUITE 600, PORTLAND, OR 97205
(503) 224-2425
(503) 224-7512
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23809
OR
Other
Enumeration date
03/12/2018
Last updated
03/12/2018
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