Provider Demographics
NPI:1750408191
Name:CASEY, JENNIFER J (ND DEGREE (NON-LIC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:CASEY
Suffix:
Gender:F
Credentials:ND DEGREE (NON-LIC
Other - Prefix:
Other - First Name:HANDS
Other - Middle Name:OF
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNM
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-0032
Mailing Address - Country:US
Mailing Address - Phone:503-890-2888
Mailing Address - Fax:
Practice Address - Street 1:12014 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4043
Practice Address - Country:US
Practice Address - Phone:360-892-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8183225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-3812849OtherFED TAX ID NUMBER S-CORP