Healthcare Provider Details

I. General information

NPI: 1013347376
Provider Name (Legal Business Name): MULTNOMAH COUNTY SCHOOL DISTRICT #U2-20JT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NW EASTMAN PKWY STE 180
GRESHAM OR
97030-3848
US

IV. Provider business mailing address

1331 NW EASTMAN PKWY
GRESHAM OR
97030-3825
US

V. Phone/Fax

Practice location:
  • Phone: 503-261-4653
  • Fax: 503-261-4669
Mailing address:
  • Phone: 503-261-4550
  • Fax: 503-261-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateOR

VIII. Authorized Official

Name: MR. JERRY JONES JR.
Title or Position: C.F.O
Credential:
Phone: 503-261-4567