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Individual

JESSE XUAN LIECHTY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1601 SW JEFFERSON AVE, CORVALLIS, OR 97331-8656
(541) 737-3424
Mailing address
51 OJITO DR, ESPANOLA, NM 87532-9429

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
PI-0014494
OR
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
02/06/2019
Last updated
05/08/2025
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