Provider Demographics
NPI:1073203006
Name:PORQUEZ, JESS
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:PORQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:PORQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1300 NW HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6277
Mailing Address - Country:US
Mailing Address - Phone:541-227-6331
Mailing Address - Fax:
Practice Address - Street 1:1300 NW HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6277
Practice Address - Country:US
Practice Address - Phone:541-227-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional