Individual
JESSICA DEFORREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, ATC
Contact information
Practice address
4080 W BROADWAY AVE STE 300, ROBBINSDALE, MN 55422-5607
(651) 231-8379
Mailing address
470 HICKORY LN N, OAKDALE, MN 55128-7037
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1755
MN
Other
Enumeration date
11/26/2011
Last updated
11/26/2011
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