Healthcare Provider Details

I. General information

NPI: 1720919061
Provider Name (Legal Business Name): HEAVENLY-GRACE HESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90971 S WILLAMETTE ST
COBURG OR
97408-9206
US

IV. Provider business mailing address

2248 WILLONA DR
EUGENE OR
97408-4733
US

V. Phone/Fax

Practice location:
  • Phone: 833-628-5433
  • Fax:
Mailing address:
  • Phone: 833-628-5433
  • Fax: 833-628-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number28609
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: