Provider Demographics
NPI:1114537917
Name:BLODGETT, JESSICA LYNN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 MEADOWS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5277
Mailing Address - Country:US
Mailing Address - Phone:971-201-1720
Mailing Address - Fax:503-210-9250
Practice Address - Street 1:4800 MEADOWS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5277
Practice Address - Country:US
Practice Address - Phone:971-201-1720
Practice Address - Fax:503-210-9250
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health