Provider Demographics
NPI:1255330700
Name:MCKEE, JANE THAYER (LAC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:THAYER
Last Name:MCKEE
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 1:12005 SW 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9634
Mailing Address - Country:US
Mailing Address - Phone:503-692-9680
Mailing Address - Fax:503-670-4954
Practice Address - Street 1:12005 SW 70TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-9634
Practice Address - Country:US
Practice Address - Phone:503-692-9680
Practice Address - Fax:503-670-4954
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist