Individual
JESSICA ANNE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
Mailing address
21417 SE OAK ST, GRESHAM, OR 97030-8438
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/01/2017
Last updated
11/01/2017
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