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1992056717
JACQUELINE B PANCOAST
PORTLAND, OR
NPI
1992056717
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR 04-11-30)
Enumeration Date
2012-09-20
Last Update Date
2012-09-20
Business Address
-- JACQUELINE B PANCOAST CADC I
1949 SE 122ND AVE
PORTLAND, OR 97233-1303
Phone number: 971-271-6313
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Mailing Address
-- JACQUELINE B PANCOAST CADC I
232 NW 6TH AVE
PORTLAND, OR 97209-3609
Phone number: 971-271-6313
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