Healthcare Provider Details

I. General information

NPI: 1619829249
Provider Name (Legal Business Name): JENNIFER WASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2026
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62239 POWELL BUTTE HWY
BEND OR
97701-9355
US

IV. Provider business mailing address

21 NE CESSNA DR UNIT 2
BEND OR
97701-5183
US

V. Phone/Fax

Practice location:
  • Phone: 541-204-1079
  • Fax:
Mailing address:
  • Phone: 518-578-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: