Provider Demographics
NPI:1467931873
Name:WILLARD, JESSICA ELIZABETH (HAS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:WILLARD
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 JANS CT
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2529
Mailing Address - Country:US
Mailing Address - Phone:541-973-7214
Mailing Address - Fax:
Practice Address - Street 1:920 TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6100
Practice Address - Country:US
Practice Address - Phone:541-414-8488
Practice Address - Fax:971-925-4120
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5055225100000X
ORHAS-P-10247472237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist