Provider Demographics
NPI:1568837235
Name:GOTZLER, JESSICA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GOTZLER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 S MACADAM AVE STE 580
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3837
Mailing Address - Country:US
Mailing Address - Phone:262-894-0826
Mailing Address - Fax:
Practice Address - Street 1:5200 S MACADAM AVE STE 580
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3837
Practice Address - Country:US
Practice Address - Phone:262-894-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical