Individual
JESSICA HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4400 NW WALNUT BLVD APT 71, CORVALLIS, OR 97330-3298
(541) 740-0708
Mailing address
4400 NW WALNUT BLVD APT 71, CORVALLIS, OR 97330-3298
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/22/2025
Last updated
12/22/2025
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