Individual
JACK BOUBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18417 SE OAK ST, PORTLAND, OR 97233-4850
(971) 727-8026
Mailing address
5415 SW WESTGATE DR, PORTLAND, OR 97221-2409
(503) 645-3581
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/07/2025
Last updated
04/07/2025
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