Healthcare Provider Details

I. General information

NPI: 1225280753
Provider Name (Legal Business Name): JASON WILCOX LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NW VALLEY VIEW DR # 107
ROSEBURG OR
97471-1760
US

IV. Provider business mailing address

1414 NW VALLEY VIEW DR # 107
ROSEBURG OR
97471-1760
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-8244
  • Fax:
Mailing address:
  • Phone: 541-900-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL13627
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: