Healthcare Provider Details

I. General information

NPI: 1417883406
Provider Name (Legal Business Name): ALICIA BRIANNA JIMENEZ CADC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14935 SE 82ND DR
CLACKAMAS OR
97015-9624
US

IV. Provider business mailing address

5150 N LOMBARD ST APT 403
PORTLAND OR
97203-4591
US

V. Phone/Fax

Practice location:
  • Phone: 503-343-8657
  • Fax: 503-343-8654
Mailing address:
  • Phone: 971-481-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number261QR0405X
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: