Provider Demographics
NPI:1295106482
Name:PALENSKY, JODI ELIZABETH JOHNSON (PHD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:ELIZABETH JOHNSON
Last Name:PALENSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1815 SW MARLOW AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5185
Mailing Address - Country:US
Mailing Address - Phone:503-292-0765
Mailing Address - Fax:503-292-5208
Practice Address - Street 1:1815 SW MARLOW AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5185
Practice Address - Country:US
Practice Address - Phone:503-292-0765
Practice Address - Fax:503-292-5208
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2306103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist