Individual
JACKIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12923 NW CORNELL RD STE 201, PORTLAND, OR 97229-5834
(503) 646-3393
(503) 672-7042
Mailing address
12923 NW CORNELL RD STE 201, PORTLAND, OR 97229-5834
(503) 646-3393
(503) 672-7042
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22647
OR
Other
Enumeration date
09/15/2016
Last updated
09/15/2016
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