- Practice location
- 369 NE Revere Ave Ste 105, Bend, OR 97701-4082
- Phone
- 541-323-3488
- Fax
- 541-323-3483
- Last updated
- December 4, 2025
Jennifer Rose Black is a Massage Therapist based in Bend, OR. Jennifer Rose Black practices in Bend, OR and has the professional credentials of LMT. The NPI Number for Jennifer Rose Black is 1568102317 and holds a License No. 15011 (OR). The current practice location address for Jennifer Rose Black is 369 NE Revere Ave Ste 105, Bend, OR 97701-4082 and can be reached out via phone at 541-323-3488 and via fax at 541-323-3483.
Provider Profile Details
- NPI Number
- 1568102317
- Provider Name
- Jennifer Rose Black
- Credential
- LMT
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 369 NE Revere Ave Ste 105, Bend, OR 97701-4082
- Phone Number
- 541-323-3488
- Fax Number
- 541-323-3483
- Primary Taxonomy
- Massage Therapist · 225700000X
- Sole Proprietor
- No
- Other Names
- Jennifer Rose Johnson (Former Name)
- Provider Enumeration Date
- March 30, 2022
- Last Update Date
- December 4, 2025
- Certification Date
- December 4, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 369 NE Revere Ave Ste 105
Bend, OR 97701-4082 - City
- Bend
- State
- Oregon
- Zip
- 97701-4082
- Phone Number
- 541-323-3488
- Fax Number
- 541-323-3483
Provider Business Mailing Address Details
- Address
- 369 NE Revere Ave Ste 105
Bend, OR 97701-4082 - City
- Bend
- State
- OR
- Zip
- 97701-4082
- Phone Number
- 541-323-3488
- Fax Number
- 541-323-3483
License Information
- License Number
- 15011
- License State
- OR
- Taxonomy
- Massage Therapist · 225700000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Jennifer R Black, LMT?
The NPI number of Jennifer R Black, LMT is 1568102317. It was assigned on March 30, 2022 and is currently active in the NPPES registry.
What is the specialty of Jennifer R Black, LMT?
Jennifer R Black, LMT is registered under the primary taxonomy Massage Therapist (code 225700000X), licensed in OR under license number 15011.
Where does Jennifer R Black, LMT practice?
The practice location is 369 NE Revere Ave Ste 105, Bend, OR 97701-4082. The office can be reached at 541-323-3488 (phone) or 541-323-3483 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1568102317 directly on the NPPES registry website.