Provider Demographics
NPI:1477333888
Name:BECK, JERROD
Entity Type:Individual
Prefix:
First Name:JERROD
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 N BORTHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1221
Mailing Address - Country:US
Mailing Address - Phone:325-283-6226
Mailing Address - Fax:
Practice Address - Street 1:13500 SE 7TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6909
Practice Address - Country:US
Practice Address - Phone:360-699-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker