Healthcare Provider Details

I. General information

NPI: 1962667253
Provider Name (Legal Business Name): JILL MARIE VANWORMER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL BOHLANDER

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E MAIN ST STE 211
HILLSBORO OR
97123-4173
US

IV. Provider business mailing address

315 E MAIN ST STE 211
HILLSBORO OR
97123-4173
US

V. Phone/Fax

Practice location:
  • Phone: 503-928-8899
  • Fax: 877-920-1872
Mailing address:
  • Phone: 503-928-8899
  • Fax: 779-201-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: