Provider Demographics
NPI:1659172922
Name:COUCH, JESSICA (MD, MCR)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COUCH
Suffix:
Gender:
Credentials:MD, MCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11719 SE BOISE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2123
Mailing Address - Country:US
Mailing Address - Phone:520-820-5041
Mailing Address - Fax:
Practice Address - Street 1:2821 DAGGETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1130
Practice Address - Country:US
Practice Address - Phone:541-274-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program