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Individual

JESSICA BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
25 SE WANAPA ST, CASCADE LOCKS, OR 97014-7002
(541) 374-8510
Mailing address
PO BOX 308, CASCADE LOCKS, OR 97014-0308

Taxonomy

Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
133396
OR

Other

Enumeration date
10/19/2016
Last updated
10/19/2016
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