Provider Demographics
NPI:1245415298
Name:STOCKER, JAMIE L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:L
Last Name:STOCKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:BRATSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6504 SE CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6628
Mailing Address - Country:US
Mailing Address - Phone:503-774-9549
Mailing Address - Fax:
Practice Address - Street 1:2410 SE 121ST AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-4066
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:503-335-5974
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional