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Individual

MRS. JESSICA ROSE WENZL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA CCCSLP

Contact information

Practice address
17727 E BURNSIDE ST, SUITE B, PORTLAND, OR 97233-4803
(503) 215-9800
Mailing address
5523 SE GLADSTONE ST, PORTLAND, OR 97206-3971
(503) 490-0579

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
13215
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0663623
TRIWEST
CA
05
GSP000390
CA
Enumeration date
11/21/2006
Last updated
10/17/2012
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