Provider Demographics
NPI:1164837076
Name:TOLLESON, JESSICA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:TOLLESON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SW ALDER ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3625
Mailing Address - Country:US
Mailing Address - Phone:503-714-5814
Mailing Address - Fax:
Practice Address - Street 1:610 SW ALDER ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3625
Practice Address - Country:US
Practice Address - Phone:503-714-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional