Individual
JESSICA DAWN EAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, MS
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 490-3900
Mailing address
6637 SE 78TH AVE, PORTLAND, OR 97206-7114
(503) 206-5256
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4188
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSIX296
—
CA
Enumeration date
03/27/2007
Last updated
07/22/2010
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