Individual
SUSAN E JACOBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. LPC
Contact information
Practice address
5228 NE HOYT ST, PORTLAND, OR 97213-3055
(503) 215-1612
(503) 215-6477
Mailing address
5228 NE HOYT ST, PORTLAND, OR 97213-3055
(503) 215-1612
(503) 215-6477
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LPC C0924
OR
Other
Enumeration date
12/17/2015
Last updated
12/17/2015
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