Individual
JESSICA GRACE BOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADCI, QMHA
Contact information
Practice address
709 NW EVERETT ST, PORTLAND, OR 97209-3517
(503) 226-4060
(503) 445-4913
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
(503) 241-7419
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
08-12-04
OR
Other
Enumeration date
06/24/2010
Last updated
06/28/2010
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