Provider Demographics
NPI:1962889675
Name:RAINEY, JESS
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:RAINEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3402
Mailing Address - Country:US
Mailing Address - Phone:503-842-5546
Mailing Address - Fax:503-815-7595
Practice Address - Street 1:1100 3RD ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3402
Practice Address - Country:US
Practice Address - Phone:503-842-5546
Practice Address - Fax:503-815-7595
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30821231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist