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1063840700
JAKE ANTONINI
TIGARD, OR
NPI
1063840700
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2013-10-16
Last Update Date
2013-10-16
Business Address
-- JAKE ANTONINI
8915 SW CENTER ST
TIGARD, OR 97223-6307
Phone number: 503-726-3698
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Mailing Address
-- JAKE ANTONINI
8915 SW CENTER ST
TIGARD, OR 97223-6307
Phone number: 503-726-3698
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