Provider Demographics
NPI:1144425638
Name:BERTAPELLE, JENNIFER S (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:BERTAPELLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 NE REGENTS DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1660
Mailing Address - Country:US
Mailing Address - Phone:971-275-4600
Mailing Address - Fax:
Practice Address - Street 1:4605 NE FREMONT ST STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1715
Practice Address - Country:US
Practice Address - Phone:503-504-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR40371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical