Provider Demographics
NPI:1164677654
Name:NETZER, JENNIFER MEYERS (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MEYERS
Last Name:NETZER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1909
Mailing Address - Country:US
Mailing Address - Phone:503-475-8642
Mailing Address - Fax:
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:STE. 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-701-8766
Practice Address - Fax:503-241-5484
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL18207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist