Individual
JENNIFER M TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1808 SE BELMONT ST, PORTLAND, OR 97214-2727
(503) 232-0007
Mailing address
1808 SE BELMONT ST, PORTLAND, OR 97214-2727
(503) 232-0007
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
Y00000X
OR
Other
Enumeration date
05/03/2012
Last updated
04/24/2017
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