Individual
JESSICA J BLADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
1103 NE ELM ST, PRINEVILLE, OR 97754-1664
(541) 306-4566
(541) 320-9005
Mailing address
PO BOX MM, MADRAS, OR 97741
(541) 777-7847
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
21-CRM-778
OR
Other
Enumeration date
12/13/2021
Last updated
12/13/2021
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