Provider Demographics
NPI:1467599142
Name:GORE, JESSICA MOLLY (LMT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MOLLY
Last Name:GORE
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 1:40106 N KENDALL RD NW
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-9529
Mailing Address - Country:US
Mailing Address - Phone:509-947-4425
Mailing Address - Fax:
Practice Address - Street 1:8530 W GAGE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7162
Practice Address - Country:US
Practice Address - Phone:509-737-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023456175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath