Individual
JESSICA PHOMMASOUVANH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14440 28TH PL N, PLYMOUTH, MN 55447-4846
(763) 337-9676
Mailing address
11705 COLORADO AVE N, CHAMPLIN, MN 55316-2503
(763) 337-9676
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/04/2025
Last updated
10/04/2025
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