Provider Demographics
NPI:1578766788
Name:FORTUNE, JANE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:FORTUNE
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 1:4333 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4000
Mailing Address - Country:US
Mailing Address - Phone:503-223-1977
Mailing Address - Fax:
Practice Address - Street 1:715 SW MORRISON ST
Practice Address - Street 2:SUITE 701
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3122
Practice Address - Country:US
Practice Address - Phone:503-297-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL40351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical