Provider Information for 1669001723
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JENNIFER MELISSA MOSS MFT
Sex: Female
NPI: 1669001723
Last Updated: 2020-04-02
Certification Date: 2020-04-02
Certification Date: 2020-04-02
Details
| Name | Value | ||||||||||||||
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| NPI | 1669001723 | ||||||||||||||
| Enumeration Date | 2020-04-02 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 12356 NE BRAZEE ST PORTLAND, OR 97230-1841 United States Phone: 808-281-1494 | Fax: | ||||||||||||||
| Primary Practice Address | 12356 NE BRAZEE ST PORTLAND, OR 97230-1841 United States Phone: 808-281-1494 | Fax: | ||||||||||||||
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