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1497925390
JACKIE LUCKETT
PORTLAND, OR
NPI
1497925390
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
172V00000X Community Health Worker
(Licence: OR 172v00000x)
Enumeration Date
2008-03-06
Last Update Date
2008-03-06
Business Address
-- JACKIE LUCKETT
1500 NE IRVING ST
PORTLAND, OR 97232-2243
Phone number: 503-258-4222
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Mailing Address
-- JACKIE LUCKETT
629 NW AUTUMNCREEK WAY APT I201
ALOHA, OR 97006-8753
Phone number: 503-515-4826
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