Provider Demographics
NPI:1770905556
Name:WORTHINGTON, JAMIE (CPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 SW 14TH ST # A
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3007
Mailing Address - Country:US
Mailing Address - Phone:775-750-9704
Mailing Address - Fax:
Practice Address - Street 1:947 SW 14TH ST # A
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-3007
Practice Address - Country:US
Practice Address - Phone:775-750-9704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7926101YM0800X
NVC1705101YM0800X
101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1770905556Medicaid
OR1770905556Medicaid