Healthcare Provider Details

I. General information

NPI: 1780042499
Provider Name (Legal Business Name): JENNIFER LEIGH HUKARI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LEIGH HELM LMT

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3758 SE MILWAUKIE AVE
PORTLAND OR
97202-3805
US

IV. Provider business mailing address

3836 SE 101ST AVE
PORTLAND OR
97266-2518
US

V. Phone/Fax

Practice location:
  • Phone: 503-840-4787
  • Fax:
Mailing address:
  • Phone: 503-840-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21900
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: