Individual
JACQUELYN TAYLOR BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
5285 SW MEADOWS RD, SUITE 170, LAKE OSWEGO, OR 97035
(503) 726-5216
(503) 726-5218
Mailing address
5285 SW MEADOWS RD, SUITE 170, LAKE OSWEGO, OR 97035
(503) 726-5216
(503) 726-5218
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19-02-02
OR
101YP2500X
Professional Counselor
Primary
C4984
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500715046
—
OR
Enumeration date
07/18/2016
Last updated
02/09/2022
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