Provider Demographics
NPI:1801388178
Name:REED, JESSICA SLOAN (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SLOAN
Last Name:REED
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 1:2215 SE MILLER ST APT 26
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6853
Mailing Address - Country:US
Mailing Address - Phone:503-442-8041
Mailing Address - Fax:
Practice Address - Street 1:8401 NE HALSEY ST STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5670
Practice Address - Country:US
Practice Address - Phone:503-206-5945
Practice Address - Fax:503-477-4511
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist