Basic Information
| Provider Information | |||||||||
| NPI: | 1114191178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHLOBOHM | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3930 SE DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972021643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034183900 | ||||||||
| FaxNumber: | 5034183939 | ||||||||
| Practice Location | |||||||||
| Address1: | 3930 SE DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972021643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034183900 | ||||||||
| FaxNumber: | 5034183939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2008 | ||||||||
| LastUpdateDate: | 02/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60226429 | WA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | L5918 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.