Provider Demographics
NPI:1609115260
Name:DALCOUR, JESSICA ROBIN (DVM)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROBIN
Last Name:DALCOUR
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29020 SW TOWN CENTER LOOP E STE 102
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9489
Mailing Address - Country:US
Mailing Address - Phone:503-682-1794
Mailing Address - Fax:503-682-2174
Practice Address - Street 1:29020 SW TOWN CENTER LOOP E STE 102
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9489
Practice Address - Country:US
Practice Address - Phone:503-682-1794
Practice Address - Fax:503-682-2174
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6035174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6035OtherOVMEB LICENSE NUMBER