Provider Demographics
NPI:1811459464
Name:HOMAN, JESSICA MARIE (CIT)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARIE
Last Name:HOMAN
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
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Mailing Address - Street 1:3555 SALMON RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:OR
Mailing Address - Zip Code:97368
Mailing Address - Country:US
Mailing Address - Phone:541-614-4437
Mailing Address - Fax:888-977-2106
Practice Address - Street 1:3555 SALMON RIVER HWY
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:OR
Practice Address - Zip Code:97368
Practice Address - Country:US
Practice Address - Phone:541-614-4437
Practice Address - Fax:888-977-2106
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)