Individual
JACKIE MCGIVERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
328 NE FAILING ST, PORTLAND, OR 97212-1157
(708) 528-5225
Mailing address
3707 SE SALMON ST, PORTLAND, OR 97214-4337
(708) 528-5225
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C4624
OR
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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