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General NPI Number Information
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NPI Number | 1194869149
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Entity Type | Individual
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Provider Name | JENNIFER ANNE SIMON-THOMAS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 4850 SW SCHOLLS FERRY RD STE 301
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City | PORTLAND
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State | OR
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Zip | 97225-1696
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Country | US
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Telephone | 503-707-0348
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Fax | 971-266-2868
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Provider Business Mailing Address
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Address Line | 5319 SW WESTGATE DR STE 168
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City | PORTLAND
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State | OR
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Zip | 97221-2430
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Country | US
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Telephone | 503-707-0348
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Fax | 971-266-2868
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 355
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2570
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License Number State | OR
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