Basic Information
| Provider Information | |||||||||
| NPI: | 1942857248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGE | ||||||||
| FirstName: | JAIMIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 SW 5TH AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972015537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666176855 | ||||||||
| FaxNumber: | 5033468015 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 SW ALDER ST STE 520 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972053620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034185311 | ||||||||
| FaxNumber: | 5034944747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2019 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L13213 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | 14940 | TX | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.