Provider Demographics
NPI:1841422342
Name:JARVIS, AMY H (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 SW 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5019
Mailing Address - Country:US
Mailing Address - Phone:503-292-9293
Mailing Address - Fax:503-645-0701
Practice Address - Street 1:14986 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5460
Practice Address - Country:US
Practice Address - Phone:503-292-9293
Practice Address - Fax:503-645-0701
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical