Provider Demographics
NPI:1811290828
Name:JONES, WENDY G (MSW, LCSW, CADCIII)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW, LCSW, CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE & PMB#548
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7708
Mailing Address - Country:US
Mailing Address - Phone:503-867-7781
Mailing Address - Fax:
Practice Address - Street 1:10255 SE 96TH AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7204
Practice Address - Country:US
Practice Address - Phone:503-867-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA2536101YM0800X
ORL53451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR090450Medicaid