Provider Demographics
NPI:1033637202
Name:JONES, KAYLIN (PHD)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SE DIVISION ST STE 115
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1085
Mailing Address - Country:US
Mailing Address - Phone:503-928-6346
Mailing Address - Fax:
Practice Address - Street 1:1235 SE DIVISION STREET, SUITE 115
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-9720
Practice Address - Country:US
Practice Address - Phone:503-928-6346
Practice Address - Fax:844-364-7112
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical