Individual
MISS JESSICA EDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
04 SW HAMILTON ST, PORTLAND, OR 97239-4095
(503) 715-6984
Mailing address
04 SW HAMILTON ST, PORTLAND, OR 97239-4095
(503) 715-6984
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10047
OR
Other
Enumeration date
03/24/2010
Last updated
03/24/2010
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