Individual
JESSICA BACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3365 SE FLOSS ST, MILWAUKIE, OR 97222-5636
(503) 314-7746
Mailing address
3365 SE FLOSS ST, MILWAUKIE, OR 97222-5636
(503) 314-7746
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17392
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17392
MASSAGE LICENSE
—
Enumeration date
11/19/2019
Last updated
11/19/2019
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