Individual
JENNIFER SUSAN BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 501-5667
Mailing address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
L5558
OR
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
06/30/2010
Last updated
11/18/2022
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