Provider Demographics
NPI:1356859052
Name:DUNCAN, JESSICA ALICE (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALICE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6428 NE PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4930
Mailing Address - Country:US
Mailing Address - Phone:786-521-1250
Mailing Address - Fax:971-703-4735
Practice Address - Street 1:2305 SE 50TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3853
Practice Address - Country:US
Practice Address - Phone:971-407-3428
Practice Address - Fax:971-407-3428
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist