Individual
DR. JENNIFER ELLERY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-A
Contact information
Practice address
3181 SW SAM JACKSON PARK RD., PORTLAND, OR 97239
(503) 494-2901
Mailing address
3181 SW SAM JACKSON PARK RD., MAIL CODE NRC04, PORTLAND, OR 97239
(503) 494-2901
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
22114
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023181
—
OR
Enumeration date
12/04/2006
Last updated
03/07/2011
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