Individual
JEANELL RUTH INNERARITY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2049 NW HOYT ST, PORTLAND, OR 97209-1260
(503) 223-8188
Mailing address
2049 NW HOYT ST, PORTLAND, OR 97209-1260
(503) 223-8188
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
225700000X
Massage Therapist
22490
OR
Other
Enumeration date
10/07/2019
Last updated
10/07/2019
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