Individual
JESSICA BRUNT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3327 SE HAWTHORNE BLVD, PORTLAND, OR 97214-5046
(503) 821-9533
Mailing address
4220 SE STARK ST, PORTLAND, OR 97215-1644
(503) 821-9533
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18698
OR
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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