Individual
JESSA FORTALIZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
605 S 2ND ST, SPRINGFIELD, OR 97477-5313
(907) 942-1689
Mailing address
605 S 2ND ST, SPRINGFIELD, OR 97477-5313
(907) 942-1689
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
110173
OR
Other
Enumeration date
11/25/2025
Last updated
11/25/2025
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