JENNIFER MARIE BOOM (NPI# 1164547634) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164547634 |
| Entity Type | Individual |
| Full Name | JENNIFER MARIE BOOM |
| Credential | LMT |
| Practice Address |
24850 Se Stark St Suite 200 Gresham OR 97030-8316 |
| Practice Telephone | 5033102622 |
| Mailing Telephone | 5033102622 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2016-11-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | 7615 | OR | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
24850 SE STARK ST SUITE 200 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-8316 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164426110 | Julia W Mason | Pediatrics | 24850 Se Stark St, Suite 150, Gresham, OR 97030-8316 | 2005-06-08 |
| 1124575139 | Gretchen Ann Grooms | Massage Therapist | 24850 Se Stark St, Suite 200, Gresham, OR 97030-8316 | 2016-09-07 |
| 1770787681 | Renee Nicole Goodreau | Obstetrics & Gynecology | 24850 Se Stark St, Suite 200, Gresham, OR 97030-8316 | 2007-06-13 |
| 1629286273 | Northwest Oral & Maxillofacial Surgeons, LLC | Dentist | 24850 Se Stark St, Suite 100, Gresham, OR 97030-8316 | 2007-05-18 |
| 1063558807 | June Ellen Hobbs | Advanced Practice Midwife | 24850 Se Stark St, Suite 200, Gresham, OR 97030-8316 | 2007-01-29 |
| 1801968086 | Mt Hood Women's Health PC | Clinic/Center | 24850 Se Stark St, Suite 200, Gresham, OR 97030 | 2006-11-14 |
| 1427066554 | Kelly Annette Carter | Obstetrics & Gynecology | 24850 Se Stark St, Suite 200, Gresham, OR 97030-8316 | 2006-08-04 |
| 1982612024 | Michelle Cecile Champagne | Obstetrics & Gynecology | 24850 Se Stark St, Suite 200, Gresham, OR 97030-8316 | 2006-08-04 |
| 1841208972 | Sandra Ann Collis | Obstetrics & Gynecology | 24850 Se Stark St, Suite 200, Gresham, OR 97030-8316 | 2006-08-04 |
| 1821006958 | Anne Meredith Knudsen | Obstetrics & Gynecology | 24850 Se Stark St, Suite 200, Gresham, OR 97030-8316 | 2006-08-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548894108 | Michael A Kostin | Massage Therapist | 3333 Sw Miller Pl, Gresham, OR 97080-5500 | 2020-02-23 |
| 1285278457 | John Robert Inouye | Massage Therapist | 16 Ne Hogan Dr Ste 108, Gresham, OR 97030-7967 | 2019-10-31 |
| 1093272627 | James Monje-lara | Massage Therapist | 1112 Nw 15th St Apt B309, Gresham, OR 97030-4960 | 2019-03-01 |
| 1346711918 | Julie Lynn Haugen | Massage Therapist | 33 Ne Kelly Ave Ste 101, Gresham, OR 97030-7518 | 2018-12-07 |
| 1306334826 | Rebecca Schrantz | Massage Therapist | 4235 Se 182nd Ave, Gresham, OR 97030-5082 | 2018-04-30 |
| 1679082861 | Erica S Blair | Massage Therapist | 1550 Nw Eastman Pkwy Ste 265, Gresham, OR 97030-3860 | 2017-09-20 |
| 1427578194 | Shawna Pool | Massage Therapist | 16 Ne Hogan Dr # 108, Gresham, OR 97030-7967 | 2017-06-23 |
| 1356888093 | Massage for Healing and Wellness | Massage Therapist | 287 Ne 3rd St Apt 209, Gresham, OR 97030-7722 | 2017-01-19 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1942757729 | Alta Ulrich | Massage Therapist | 7932 Se 282nd Ave, Gresham, OR 97080-8217 | 2016-09-08 |
| Find all providers in GRESHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.