Provider Demographics
NPI:1801527221
Name:CAMPOLA, JESSICA MARILYN (CRM, CADC-R)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARILYN
Last Name:CAMPOLA
Suffix:
Gender:F
Credentials:CRM, CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 SE LILLY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1882
Mailing Address - Country:US
Mailing Address - Phone:541-286-0147
Mailing Address - Fax:
Practice Address - Street 1:426 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6409
Practice Address - Country:US
Practice Address - Phone:541-286-4439
Practice Address - Fax:541-250-5178
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-21-1323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)