Basic Information
| Provider Information | |||||||||
| NPI: | 1437584125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGLISH | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | JACKSON | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 LANCASTER DR NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035856388 | ||||||||
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| Practice Location | |||||||||
| Address1: | 681 SITKA DEER CT NW | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973043685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187956970 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2013 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L6113 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 29871 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.