Provider Demographics
NPI:1629433206
Name:PEACOCK, JESSICA (CSWA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:018 SW BOUNDARY CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3939
Mailing Address - Country:US
Mailing Address - Phone:503-222-9661
Mailing Address - Fax:
Practice Address - Street 1:375 NW BEAVER ST STE 101
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1802
Practice Address - Country:US
Practice Address - Phone:541-383-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker