Healthcare Provider Details

I. General information

NPI: 1902422835
Provider Name (Legal Business Name): JASON WILKINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10580 SW MCDONALD ST STE 202
TIGARD OR
97224-4800
US

IV. Provider business mailing address

4130 SW 117TH AVE # A262
BEAVERTON OR
97005-5606
US

V. Phone/Fax

Practice location:
  • Phone: 503-389-5514
  • Fax:
Mailing address:
  • Phone: 503-389-5514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberT2352
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: