Provider Demographics
NPI:1952154338
Name:VASELANEY, JENNIFER JEAN (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:VASELANEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OR
Mailing Address - Zip Code:97002-0671
Mailing Address - Country:US
Mailing Address - Phone:971-303-1270
Mailing Address - Fax:
Practice Address - Street 1:21561 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OR
Practice Address - Zip Code:97002-9233
Practice Address - Country:US
Practice Address - Phone:971-298-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORORLMT26828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist