MEDICARE: JESSICA GILBERTSON HITCHCOCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	MD23993	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477552305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GILBERTSON HITCHCOCK MD

Provider Business Mailing Address
First Line	:	3439 NE SANDY BLVD, PMB 375
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232
Country	:	US
Telephone Number	:	503-284-8841
Fax Number	:	503-282-3302

Provider Business Practice Location Address
First Line	:	4805 NE GLISAN ST
Second Line	:	E3
City	:	PORTLAND
State	:	OR
Zip	:	97213-2933
Country	:	US
Telephone Number	:	503-284-8841
Fax Number	:	503-282-3302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/01/2017

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