Individual
JESSICA M GLOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CADCI
Contact information
Practice address
5329 NE MARTIN LUTHER KING BLVD, PORTLAND, OR 97211-3237
(503) 988-5183
(503) 988-5182
Mailing address
421 SW OAK ST, STE. 210, PORTLAND, OR 97204-1817
(503) 988-7468
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10-06-18
OR
1041C0700X
Clinical Social Worker
Primary
L5148
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
05
—
096511
—
OR
Enumeration date
02/07/2012
Last updated
04/11/2016
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