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General NPI Number Information
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NPI Number | 1619495538
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Entity Type | Individual
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Provider Name | JESSICA ROSE ROSS
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Gender | Female
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 08/30/2017
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Provider Practice Location Address
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Address Line | 1302 A ST
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City | HOOD RIVER
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State | OR
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Zip | 97031-1648
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Country | US
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Telephone | 541-806-0525
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 HOOD RIVER RD
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City | MOSIER
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State | OR
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Zip | 97040-9751
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Country | US
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Telephone | 541-399-3784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18278
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License Number State | OR
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