Provider Demographics
NPI:1376192765
Name:BARDA, JOCELYN KIM (MS)
Entity Type:Individual
Prefix:MS
First Name:JOCELYN
Middle Name:KIM
Last Name:BARDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 NE FLANDERS ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3259
Mailing Address - Country:US
Mailing Address - Phone:503-290-4078
Mailing Address - Fax:
Practice Address - Street 1:2926 NE FLANDERS ST STE 3C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3259
Practice Address - Country:US
Practice Address - Phone:503-290-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist