Provider Demographics
NPI:1790846236
Name:MCGRATH, JESSAMYN M (LMT)
Entity Type:Individual
Prefix:
First Name:JESSAMYN
Middle Name:M
Last Name:MCGRATH
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 1:837 NE ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3832
Mailing Address - Country:US
Mailing Address - Phone:503-754-6247
Mailing Address - Fax:
Practice Address - Street 1:2133 NE BROADWAY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1878
Practice Address - Country:US
Practice Address - Phone:503-754-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7187171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor