Healthcare Provider Details

I. General information

NPI: 1205277084
Provider Name (Legal Business Name): JILL ELAINE CAIN M.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28925 SW BOBERG RD
WILSONVILLE OR
97070-8218
US

IV. Provider business mailing address

29545 SW COFFEE LAKE DR
WILSONVILLE OR
97070-3079
US

V. Phone/Fax

Practice location:
  • Phone: 503-318-3083
  • Fax: 503-893-3044
Mailing address:
  • Phone: 503-318-3083
  • Fax: 503-893-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2881
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: