Provider Demographics
NPI:1396552717
Name:HOUSTON, JASON ALLEN MICHAEL
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN MICHAEL
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15581 SE WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4230
Mailing Address - Country:US
Mailing Address - Phone:503-737-7044
Mailing Address - Fax:
Practice Address - Street 1:15581 SE WEBSTER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4230
Practice Address - Country:US
Practice Address - Phone:503-737-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-3504175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist