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General NPI Number Information
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NPI Number | 1871015941
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Entity Type | Individual
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Provider Name | JEROME M SLOAN II LCSW/CADC III//QMHP
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Gender | Male
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1110 SE ALDER ST. SUITE 301 PMB #51
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City | PORTLAND
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State | OR
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Zip | 97214
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Country | US
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Telephone | 541-212-7089
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Fax |
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Provider Business Mailing Address
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Address Line | 5606 N WILLIAMS AVE
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City | PORTLAND
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State | OR
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Zip | 97217-2455
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Country | US
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Telephone | 541-212-7089
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | L10965
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 21-06-30017
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License Number State | OR
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