Healthcare Provider Details

I. General information

NPI: 1134264401
Provider Name (Legal Business Name): JENNIFER MARIE HEADLEY HOBBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER HEADLEY

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19185 SW 90TH AVE
TUALATIN OR
97062-7558
US

IV. Provider business mailing address

500 NE MULTNOMAH ST STE 100
PORTLAND OR
97232-2099
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 800-813-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWI.LW.61464978
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4328
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: