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General NPI Number Information
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NPI Number | 1982008579
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Entity Type | Individual
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Provider Name | JENNIFER CORK LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 5285 MEADOWS RD STE 170
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3478
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Country | US
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Telephone | 503-726-5216
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Fax | 503-726-5218
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Provider Business Mailing Address
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Address Line | 503 EAGLE VIEW DR NW
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City | SALEM
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State | OR
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Zip | 97304-4253
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Country | US
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Telephone | 208-301-8975
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-36286
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L13053
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License Number State | OR
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