Provider Demographics
NPI:1356730956
Name:WARD, JENNIFER M (LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WARD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3970 N INTERSTATE AVE
Mailing Address - Street 2:UNIT 309
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1082
Mailing Address - Country:US
Mailing Address - Phone:917-701-5678
Mailing Address - Fax:
Practice Address - Street 1:4847 MEADOWS RD
Practice Address - Street 2:SUITE 153
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2509
Practice Address - Country:US
Practice Address - Phone:503-719-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC170268171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist