Individual
MRS. CONSTANCE JO ERVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
289 E ELLENDALE AVE, SUITE 102, DALLAS, OR 97338-1580
(503) 623-5505
Mailing address
289 E ELLENDALE AVE, SUITE 102, DALLAS, OR 97338-1580
(503) 623-5505
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17273
OR
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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