Healthcare Provider Details

I. General information

NPI: 1295995231
Provider Name (Legal Business Name): JANE E. HUEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE ELLEN COLE

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 82ND DR
GLADSTONE OR
97027-1803
US

IV. Provider business mailing address

PO BOX 82819
PORTLAND OR
97282-0819
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-5515
  • Fax: 503-659-1994
Mailing address:
  • Phone: 503-233-5405
  • Fax: 503-233-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4713
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier178438101
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: