Individual
JACQUELINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
485 ALEXANDER LOOP STE 110, EUGENE, OR 97401-6753
(541) 423-7009
Mailing address
PO BOX 21112, EUGENE, OR 97402-0356
(678) 687-8196
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19559
OR
225700000X
Massage Therapist
46-2071391
OR
Other
Enumeration date
02/03/2016
Last updated
10/08/2019
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