Healthcare Provider Details

I. General information

NPI: 1619889961
Provider Name (Legal Business Name): JO HEMENWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HAILEE HEMENWAY

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 SE MORRISON ST STE 200
PORTLAND OR
97214-2462
US

IV. Provider business mailing address

1235 SE MORRISON ST STE 200
PORTLAND OR
97214-2462
US

V. Phone/Fax

Practice location:
  • Phone: 503-746-3373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: