Provider Demographics
NPI:1053118752
Name:JESSICA DAVISON LCSW LLC
Entity type:Organization
Organization Name:JESSICA DAVISON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-758-9133
Mailing Address - Street 1:2806 SW GOODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1723
Mailing Address - Country:US
Mailing Address - Phone:503-758-9133
Mailing Address - Fax:
Practice Address - Street 1:1100 SOUTHGATE STE 3
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3971
Practice Address - Country:US
Practice Address - Phone:541-215-4440
Practice Address - Fax:541-429-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty