Provider Demographics
NPI:1134314735
Name:KIERAS, JESSICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:KIERAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19800 VILLAGE OFFICE CT STE 205
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1813
Mailing Address - Country:US
Mailing Address - Phone:458-206-3579
Mailing Address - Fax:
Practice Address - Street 1:19800 VILLAGE OFFICE CT STE 205
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1813
Practice Address - Country:US
Practice Address - Phone:458-206-3579
Practice Address - Fax:844-603-7385
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist