Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | A12077 | OR |
NPI | 1003427915 |
---|---|
Provider Name | April Charee Jackson |
First Address | Portland, OR 97219-5466 |
Second Address | Portland, OR 97230-1911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2020 |
Last Update Date | 11/10/2021 |