Provider Demographics
NPI:1295095354
Name:TAYLOR, JENNIFER MARIE (MSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14600 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5442
Mailing Address - Country:US
Mailing Address - Phone:503-752-2391
Mailing Address - Fax:503-690-9605
Practice Address - Street 1:14600 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5442
Practice Address - Country:US
Practice Address - Phone:503-752-2391
Practice Address - Fax:503-690-9605
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL64921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500674446Medicaid