Healthcare Provider Details

I. General information

NPI: 1184596611
Provider Name (Legal Business Name): JACKSON HENRY PARKER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 10/24/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22518 S PARROT CREEK RD
OREGON CITY OR
97045-9725
US

IV. Provider business mailing address

14389 S MAPLELANE RD
OREGON CITY OR
97045-8883
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-3050
  • Fax:
Mailing address:
  • Phone: 503-266-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: