Individual
JESSICA NICOLE GOODPASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215138425
—
OR
Enumeration date
09/15/2022
Last updated
10/02/2024
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