Individual
JACQUELINE HEEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
51385 SW OLD PORTLAND RD STE E, SCAPPOOSE, OR 97056-4062
(503) 543-7768
Mailing address
9322 N CHARLESTON AVE, PORTLAND, OR 97203-2204
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-10169822
OR
Other
Enumeration date
02/10/2019
Last updated
02/10/2019
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