Provider Demographics
NPI:1982192571
Name:THOMAS, JESSICA (CPD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04112-0023
Mailing Address - Country:US
Mailing Address - Phone:207-558-2229
Mailing Address - Fax:
Practice Address - Street 1:619 BRIGHTON AVE #101
Practice Address - Street 2:ROSEMONT WELLNESS CENTER
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-558-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9-201621374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula