Provider Demographics
NPI:1952866337
Name:XIONG, JESSICA KABAO (MA, LPC, NLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KABAO
Last Name:XIONG
Suffix:
Gender:F
Credentials:MA, LPC, NLC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KABAO
Other - Last Name:VANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5305 RIVER RD N STE B
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5324
Mailing Address - Country:US
Mailing Address - Phone:770-361-4523
Mailing Address - Fax:
Practice Address - Street 1:5305 RIVER RD N STE B
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:770-361-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC6594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health