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General NPI Number Information
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NPI Number | 1508015975
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Entity Type | Individual
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Provider Name | JACOB DICKINSON M.A.
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Gender | Male
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 9670 SW BEAVERTON HILLSDALE HWY
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City | BEAVERTON
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State | OR
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Zip | 97005-3307
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Country | US
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Telephone | 971-229-4009
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Fax | 866-324-6009
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Provider Business Mailing Address
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Address Line | 10824 SE OAK ST STE 314
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City | MILWAUKIE
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State | OR
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Zip | 97222-6694
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Country | US
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Telephone | 971-229-4009
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Fax | 866-324-6009
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0845
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License Number State | OR
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