Provider Demographics
NPI:1396980413
Name:BARRON, JESSILYN LEIGH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JESSILYN
Middle Name:LEIGH
Last Name:BARRON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12250 SW 2ND ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2828
Mailing Address - Country:US
Mailing Address - Phone:503-526-1715
Mailing Address - Fax:503-526-1752
Practice Address - Street 1:12250 SW 2ND ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2828
Practice Address - Country:US
Practice Address - Phone:503-526-1715
Practice Address - Fax:503-526-1752
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL3845104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker