Healthcare Provider Details

I. General information

NPI: 1598071805
Provider Name (Legal Business Name): JESSICA TERESA LOEHNDORF HUTCHISON M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SE HAWTHORNE BLVD SUITE 100
PORTLAND OR
97214-3538
US

IV. Provider business mailing address

712 SE HAWTHORNE BLVD SUITE 100
PORTLAND OR
97214-3538
US

V. Phone/Fax

Practice location:
  • Phone: 503-333-9387
  • Fax:
Mailing address:
  • Phone: 503-333-9387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberR1820
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: