Provider Demographics
NPI:1477552305
Name:HITCHCOCK, JESSICA GILBERTSON (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GILBERTSON
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 NE SANDY BLVD, PMB 375
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-284-8841
Mailing Address - Fax:503-282-3302
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:E3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-284-8841
Practice Address - Fax:503-282-3302
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD239932084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286343Medicaid
OR286343Medicaid