Provider Demographics
NPI:1518388495
Name:RICHARDS, JESSICA ANNE (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:SPREADBOROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 92900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0900
Mailing Address - Country:US
Mailing Address - Phone:503-255-3404
Mailing Address - Fax:503-255-4750
Practice Address - Street 1:10101 SE MAIN ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2455
Practice Address - Country:US
Practice Address - Phone:503-255-3404
Practice Address - Fax:503-255-4750
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR86006836133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered