Provider Demographics
NPI:1134881246
Name:KREMM, JESSICA LORRAINE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LORRAINE
Last Name:KREMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 SW 214TH PL
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-1622
Mailing Address - Country:US
Mailing Address - Phone:979-451-1671
Mailing Address - Fax:
Practice Address - Street 1:2471 SW 214TH PL
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-1622
Practice Address - Country:US
Practice Address - Phone:979-451-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health