Provider Demographics
NPI:1659977726
Name:WRIGHT, JEAN RENE
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:RENE
Last Name:WRIGHT
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 1:738 NE DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2931
Mailing Address - Country:US
Mailing Address - Phone:503-542-4603
Mailing Address - Fax:
Practice Address - Street 1:2609 NE 93RD AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-7425
Practice Address - Country:US
Practice Address - Phone:360-891-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker