Individual
JESSICA LAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1724 MAPLE ST APT 7, NORTH BEND, OR 97459-2171
(503) 729-9363
Mailing address
1724 MAPLE ST APT 7, NORTH BEND, OR 97459-2171
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/14/2020
Last updated
08/14/2020
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