Individual
JACK CHARLES SKILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
182 S.W. ACADEMY ST., 304 ACADEMY BUILDING, DALLAS, OR 97338-1922
(503) 831-5971
(503) 831-1726
Mailing address
182 SW ACADEMY ST, SUITE 304, DALLAS, OR 97338-1922
(503) 831-5971
(503) 831-1726
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Enumeration date
09/29/2009
Last updated
09/29/2009
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