Provider Demographics
NPI:1750733093
Name:HUNTLEY, JESSICA S (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SWINFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2264 MCGILCHRIST ST SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1008
Mailing Address - Country:US
Mailing Address - Phone:503-581-7700
Mailing Address - Fax:503-581-7799
Practice Address - Street 1:2264 MCGILCHRIST ST SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1008
Practice Address - Country:US
Practice Address - Phone:503-581-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL86271041C0700X, 1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health