Healthcare Provider Details

I. General information

NPI: 1255112405
Provider Name (Legal Business Name): JESSICA ANN TRUMP MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 VANDENBERG RD
KLAMATH FALLS OR
97603-3730
US

IV. Provider business mailing address

3331 VANDENBERG RD
KLAMATH FALLS OR
97603-3730
US

V. Phone/Fax

Practice location:
  • Phone: 541-851-3882
  • Fax:
Mailing address:
  • Phone: 541-883-4296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: