Provider Demographics
NPI:1700104932
Name:WATSON, JAMIE ANN (MA, LMFT, RPT-S)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:MA, LMFT, RPT-S
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:BONFIGLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:113 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3519
Mailing Address - Country:US
Mailing Address - Phone:503-263-8903
Mailing Address - Fax:
Practice Address - Street 1:113 N ELM ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3519
Practice Address - Country:US
Practice Address - Phone:503-263-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61342033106H00000X
ORT1016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500640457Medicaid