Individual
JODI WINNWALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, MT-BC
Contact information
Practice address
2136 1/2 NE 8TH AVE, PORTLAND, OR 97212
(503) 284-6794
Mailing address
2136 1/2 NE 8TH AVE, PORTLAND, OR 97212
(503) 284-6794
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L3722
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L3722
LICENSED CLINICAL SOCIAL WORKER
OR
Enumeration date
01/06/2009
Last updated
01/06/2009
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