Healthcare Provider Details

I. General information

NPI: 1487879623
Provider Name (Legal Business Name): GUIDED HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 SW 12TH ST
SHERWOOD OR
97140-6020
US

IV. Provider business mailing address

16660 SW 12TH ST
SHERWOOD OR
97140-6020
US

V. Phone/Fax

Practice location:
  • Phone: 503-260-0116
  • Fax:
Mailing address:
  • Phone: 503-260-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00950
License Number StateOR

VIII. Authorized Official

Name: MS. JENNIE V KJOS
Title or Position: PRESIDENT
Credential: LAC, RPH
Phone: 503-260-0116