Provider Demographics
NPI:1326727413
Name:AZZOPARDI, JESSE H
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:H
Last Name:AZZOPARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:H
Other - Last Name:AZZOPARDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDS
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-0752
Mailing Address - Country:US
Mailing Address - Phone:503-662-9222
Mailing Address - Fax:
Practice Address - Street 1:136 NE 7TH AVE APT C
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3271
Practice Address - Country:US
Practice Address - Phone:503-662-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1837992-96405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional