Provider Demographics
NPI:1649403940
Name:BINKLEY, JESSICA LAUREN (PSYD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:BINKLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15220 NW LAIDLAW RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7717
Mailing Address - Country:US
Mailing Address - Phone:800-452-3563
Mailing Address - Fax:503-418-2401
Practice Address - Street 1:15220 NW LAIDLAW RD STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-7717
Practice Address - Country:US
Practice Address - Phone:800-452-3563
Practice Address - Fax:503-418-2401
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
OR2428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program