Provider Demographics
NPI:1780955823
Name:KLEINT, JAKOB WILSON (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JAKOB
Middle Name:WILSON
Last Name:KLEINT
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:KLEINT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:8235 SW OLESON RD STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6998
Mailing Address - Country:US
Mailing Address - Phone:971-272-7211
Mailing Address - Fax:503-719-6930
Practice Address - Street 1:8235 SW OLESON RD STE B&C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6998
Practice Address - Country:US
Practice Address - Phone:971-272-7211
Practice Address - Fax:503-719-6930
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL84571041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical