Healthcare Provider Details

I. General information

NPI: 1346152170
Provider Name (Legal Business Name): ROOST PERINATAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 NE GARFIELD AVE
PORTLAND OR
97211-2913
US

IV. Provider business mailing address

6845 NE GARFIELD AVE
PORTLAND OR
97211-2913
US

V. Phone/Fax

Practice location:
  • Phone: 503-929-9515
  • Fax:
Mailing address:
  • Phone: 503-929-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JESSA MOON
Title or Position: CO-FOUNDER
Credential:
Phone: 503-929-9515