Individual
JENNIFER TICKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CST/CSFA
Contact information
Practice address
10152 SILVERTON RD NE, SILVERTON, OR 97381-9306
(503) 480-9887
Mailing address
10152 SILVERTON RD NE, SILVERTON, OR 97381-9306
(503) 480-9887
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
126088
OR
Other
Enumeration date
06/10/2011
Last updated
06/10/2011
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