Provider Demographics
NPI:1578242020
Name:JANSEN, TARYN (LMT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:JANSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 SE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2701
Mailing Address - Country:US
Mailing Address - Phone:503-939-6472
Mailing Address - Fax:
Practice Address - Street 1:4922 N VANCOUVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2826
Practice Address - Country:US
Practice Address - Phone:503-493-9398
Practice Address - Fax:503-493-9518
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27747225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist