Individual
JOLENA MAE MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
7916 SE FOSTER RD, PORTLAND, OR 97206-4289
(503) 946-8745
Mailing address
7916 SE FOSTER RD, PORTLAND, OR 97206-4289
(503) 946-8745
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
17-CRM-213
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17-CRM-213
—
OR
Enumeration date
04/26/2018
Last updated
04/26/2018
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