Provider Demographics
NPI:1508297912
Name:SWEET, JESSICA CARLI (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:CARLI
Last Name:SWEET
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5456
Mailing Address - Country:US
Mailing Address - Phone:513-728-1555
Mailing Address - Fax:
Practice Address - Street 1:6230 NE 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5456
Practice Address - Country:US
Practice Address - Phone:513-728-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR165885171100000X
OR1997175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist