Provider Demographics
NPI:1811010200
Name:HODGES, JESSICA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:HODGES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5290 BAXTER CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1538
Mailing Address - Country:US
Mailing Address - Phone:503-949-4053
Mailing Address - Fax:503-339-2966
Practice Address - Street 1:1661 EDGEWATER ST NW
Practice Address - Street 2:SUITE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4711
Practice Address - Country:US
Practice Address - Phone:503-949-4053
Practice Address - Fax:503-339-2966
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist