Provider Demographics
NPI:1497733596
Name:ALEXANDER, JAN SNYDER (LCSW)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:SNYDER
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SE 28TH AVENUE
Mailing Address - Street 2:CONDO 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-804-1627
Mailing Address - Fax:
Practice Address - Street 1:1210 SE OAK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1427
Practice Address - Country:US
Practice Address - Phone:503-804-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL51921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR81886Medicare PIN