Provider Demographics
NPI:1790127140
Name:SCHUTZ, JESSICA LINLEY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LINLEY
Last Name:SCHUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LINLEY
Other - Last Name:KREIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8221 SE 75TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-8625
Mailing Address - Country:US
Mailing Address - Phone:503-756-1600
Mailing Address - Fax:
Practice Address - Street 1:8221 SE 75TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-8625
Practice Address - Country:US
Practice Address - Phone:503-756-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OR15424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist