Provider Demographics
NPI:1831204767
Name:PELOSI, JEAN MARIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIA
Last Name:PELOSI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 KRUSE WAY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3594
Mailing Address - Country:US
Mailing Address - Phone:503-697-0600
Mailing Address - Fax:503-635-0583
Practice Address - Street 1:4550 KRUSE WAY
Practice Address - Street 2:SUITE 225
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3594
Practice Address - Country:US
Practice Address - Phone:503-697-0600
Practice Address - Fax:503-635-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical