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1053621912
JACOB RUSSELL MOSS
PORTLAND, OR
NPI
1053621912
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
104100000X Social Worker
Enumeration Date
2010-10-13
Last Update Date
2014-07-24
Business Address
-- JACOB RUSSELL MOSS
12636 SE STARK ST PLAZA 125, BLDG J
PORTLAND, OR 97233-1058
Phone number: 503-253-4600
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Mailing Address
-- JACOB RUSSELL MOSS
PO BOX 82819
PORTLAND, OR 97282-0819
Phone number: 801-233-5405
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