Provider Demographics
NPI:1548458607
Name:JACOBSEN, JESSICA C (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:C
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SW 4TH AVE STE 520
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1825
Mailing Address - Country:US
Mailing Address - Phone:503-867-4379
Mailing Address - Fax:
Practice Address - Street 1:209 SW 4TH AVE STE 520
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1825
Practice Address - Country:US
Practice Address - Phone:503-867-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL71511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical