Provider Demographics
NPI:1225324700
Name:WIMMER, JENNIFER CLAIRE (LCSW, PWS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:WIMMER
Suffix:
Gender:F
Credentials:LCSW, PWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2569
Mailing Address - Country:US
Mailing Address - Phone:503-489-9130
Mailing Address - Fax:
Practice Address - Street 1:905 SE 14TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2569
Practice Address - Country:US
Practice Address - Phone:503-622-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORA4248104100000X
OR175T00000X
ORL10451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No175T00000XOther Service ProvidersPeer Specialist