Provider Demographics
NPI:1801427802
Name:HOUSTON, JENNIFER RUTH (LMT, AAS)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:RUTH
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LMT, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23891 WINLOCK LN
Mailing Address - Street 2:
Mailing Address - City:FOSSIL
Mailing Address - State:OR
Mailing Address - Zip Code:97830-8235
Mailing Address - Country:US
Mailing Address - Phone:503-739-3488
Mailing Address - Fax:
Practice Address - Street 1:23891 WINLOCK LN
Practice Address - Street 2:
Practice Address - City:FOSSIL
Practice Address - State:OR
Practice Address - Zip Code:97830-8235
Practice Address - Country:US
Practice Address - Phone:503-739-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist