Individual
JACOB WICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2800 N VANCOUVER AVE STE 165, PORTLAND, OR 97227-1644
(503) 413-2902
(503) 413-5220
Mailing address
PO BOX 4399, PORTLAND, OR 97208-4399
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
0858761
NY
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
L8045
OR
Other
Enumeration date
07/28/2015
Last updated
02/04/2020
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