Healthcare Provider Details

I. General information

NPI: 1649506809
Provider Name (Legal Business Name): JESSE REMER HENDERSON BCD, PCD, LCCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 SE CLINTON ST
PORTLAND OR
97202-1132
US

IV. Provider business mailing address

PO BOX 14100
PORTLAND OR
97293-0100
US

V. Phone/Fax

Practice location:
  • Phone: 503-407-4732
  • Fax: 503-922-1173
Mailing address:
  • Phone: 503-407-4732
  • Fax: 503-922-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: