Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | LD-D-10190313 | OR |
NPI | 1144726019 |
---|---|
Provider Name | Mrs. Jessica Sok Hazen |
First Address | Portland, OR 97221-2549 |
Second Address | Portland, OR 97221-2549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2018 |
Last Update Date | 01/04/2018 |