Healthcare Provider Details

I. General information

NPI: 1568954188
Provider Name (Legal Business Name): JORDAN HUBCHIK LPC, LCAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JORDAN WAGNER

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 S MACADAM AVE #4202
PORTLAND OR
97239-6106
US

IV. Provider business mailing address

5441 S MACADAM AVE #4202
PORTLAND OR
97239-6106
US

V. Phone/Fax

Practice location:
  • Phone: 503-713-5674
  • Fax:
Mailing address:
  • Phone: 503-713-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberART-C-10209317
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5953
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: