Provider Demographics
NPI:1972847622
Name:STEWART, JENNY LYNN (LAC)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:LYNN
Last Name:STEWART
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 NE HALSEY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5670
Mailing Address - Country:US
Mailing Address - Phone:503-567-8589
Mailing Address - Fax:
Practice Address - Street 1:8401 NE HALSEY ST STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5670
Practice Address - Country:US
Practice Address - Phone:503-567-8589
Practice Address - Fax:971-302-2226
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC158944171100000X
ORAC159844171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty