Provider Demographics
NPI:1780724393
Name:REID, JENNIFER CAROLE (ND)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CAROLE
Last Name:REID
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27530 SE DIVISION DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8214
Mailing Address - Country:US
Mailing Address - Phone:503-492-9427
Mailing Address - Fax:503-492-7958
Practice Address - Street 1:27530 SE DIVISION DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8214
Practice Address - Country:US
Practice Address - Phone:503-492-9427
Practice Address - Fax:503-492-7958
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR920175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath