Healthcare Provider Details

I. General information

NPI: 1467599142
Provider Name (Legal Business Name): JESSICA MOLLY GORE L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 W GAGE BLVD SUITE B
KENNEWICK WA
99336-7162
US

IV. Provider business mailing address

40106 N KENDALL RD NW
BENTON CITY WA
99320-9529
US

V. Phone/Fax

Practice location:
  • Phone: 509-737-1400
  • Fax:
Mailing address:
  • Phone: 509-947-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMA00023456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: