Active NPI
Jamie Vandergon, MS, LPC
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1295899649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- C1983
- Practice address
- 3550 SE Woodward St
Portland, OR 97202-1552 - Phone
- (503) 813-7769
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C1983 | OR | Primary |
Addresses
Primary practice location
3550 SE Woodward St
Portland, OR 97202-1552
Mailing address
3550 SE Woodward St
Portland, OR 97202-1552
Phone (503) 813-7769
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1983 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187222400000",
"number": "1295899649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3550 SE WOODWARD ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972021552",
"telephone_number": "503-813-7769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3550 SE WOODWARD ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972021552",
"telephone_number": "503-813-7769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERGON",
"first_name": "JAMIE",
"credential": "MS, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2007-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "C1983",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.