MEDICARE: JAY WILKINSON

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	103TC0700X	Clinical Psychologist	2159	OR
2	103TB0200X	Cognitive & Behavioral Psychologist	2159	OR

General Provider Information

NPI Number	:	1497809164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY WILKINSON

Provider Business Mailing Address
First Line	:	5441 S MACADAM AVE # 6038
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-6106
Country	:	US
Telephone Number	:	503-462-1606
Fax Number	:

Provider Business Practice Location Address
First Line	:	5441 S MACADAM AVE # 6038
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-6106
Country	:	US
Telephone Number	:	503-462-1606
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	05/15/2026

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