Provider Demographics
NPI:1013663657
Name:VISSCHER, JILLIAN MCGRANAHAN (MA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MCGRANAHAN
Last Name:VISSCHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16301 SE VAN ZYL DR
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-8883
Mailing Address - Country:US
Mailing Address - Phone:971-533-6803
Mailing Address - Fax:
Practice Address - Street 1:533 NE 87TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5840
Practice Address - Country:US
Practice Address - Phone:971-533-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional