Healthcare Provider Details

I. General information

NPI: 1245808336
Provider Name (Legal Business Name): JACLYNNE MARIE HEDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S BOND AVE BLDG 1
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 S BOND AVE BLDG 1
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2021022958
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD224179
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: