Provider Demographics
NPI:1811367915
Name:BRANDES, JESSICA (ND)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:BRANDES
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 SW 5TH AVE
Mailing Address - Street 2:#394
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5277
Mailing Address - Country:US
Mailing Address - Phone:503-389-8863
Mailing Address - Fax:503-914-1634
Practice Address - Street 1:220 NW 8TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3503
Practice Address - Country:US
Practice Address - Phone:503-389-8863
Practice Address - Fax:503-914-1634
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3025175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath