Provider Demographics
NPI:1891118139
Name:JESSICA BROOKE HUFFMAN, LLC
Entity Type:Organization
Organization Name:JESSICA BROOKE HUFFMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-841-6828
Mailing Address - Street 1:2 NW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3907
Mailing Address - Country:US
Mailing Address - Phone:503-841-6828
Mailing Address - Fax:
Practice Address - Street 1:2 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3907
Practice Address - Country:US
Practice Address - Phone:503-841-6828
Practice Address - Fax:503-515-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1860175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty