Provider Demographics
NPI:1134446842
Name:ZUELKE, JEAN LOUISE (LMT)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LOUISE
Last Name:ZUELKE
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 1:1470 SW MAPLECREST DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6434
Mailing Address - Country:US
Mailing Address - Phone:503-245-7837
Mailing Address - Fax:
Practice Address - Street 1:333 S STATE ST
Practice Address - Street 2:SUITE W
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3932
Practice Address - Country:US
Practice Address - Phone:503-636-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2721225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist