Basic Information
| Provider Information | |||||||||
| NPI: | 1639340383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JAIMIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW, LICSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 426 SW STARK ST FL 5 | ||||||||
| Address2: | WESTSIDE CLINIC | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972042347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039885140 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 426 SW STARK ST FL 5 | ||||||||
| Address2: | WESTSIDE CLINIC | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972042347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039885140 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2008 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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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 | 113886 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.