Provider Demographics
NPI:1992846166
Name:STATZ, JAYNE EVELYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:EVELYN
Last Name:STATZ
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 1:1962 NW KEARNEY ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1400
Mailing Address - Country:US
Mailing Address - Phone:503-223-8536
Mailing Address - Fax:503-223-4271
Practice Address - Street 1:1962 NW KEARNEY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1400
Practice Address - Country:US
Practice Address - Phone:503-223-8536
Practice Address - Fax:503-223-4271
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0005080302OtherAETNA