Provider Demographics
NPI:1093810509
Name:BURCH PESSES, JANE (LAC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BURCH PESSES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-7339
Mailing Address - Country:US
Mailing Address - Phone:503-992-1443
Mailing Address - Fax:503-316-1970
Practice Address - Street 1:2004 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-7339
Practice Address - Country:US
Practice Address - Phone:503-992-1443
Practice Address - Fax:503-316-1970
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00675171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist