Individual
JASON UTHENWOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7105 NE 40TH ST, VANCOUVER, WA 98661-3058
(503) 535-1153
Mailing address
4411 NE EMERSON ST, PORTLAND, OR 97218-1537
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001787210017872
BCBS
OR
Enumeration date
02/25/2021
Last updated
05/12/2025
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