Healthcare Provider Details

I. General information

NPI: 1114469897
Provider Name (Legal Business Name): JAIMIE HUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N DIXON ST
PORTLAND OR
97227-1804
US

IV. Provider business mailing address

5325 NE SACRAMENTO ST
PORTLAND OR
97213-2663
US

V. Phone/Fax

Practice location:
  • Phone: 503-916-2000
  • Fax:
Mailing address:
  • Phone: 503-830-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number545203
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: