Provider Demographics
NPI:1598318701
Name:SPINU, JESSICA (HIS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SPINU
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1646
Mailing Address - Country:US
Mailing Address - Phone:971-888-4357
Mailing Address - Fax:503-236-3513
Practice Address - Street 1:4105 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1646
Practice Address - Country:US
Practice Address - Phone:971-888-4357
Practice Address - Fax:503-236-3513
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-T-10200947237700000X
ORHAS-P-10205778237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist