Active NPI
Jillian Davis
- Social Worker
- Portland, OR
National Provider Identifier
1316310063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- M6584
- Practice address
- 3716 NE MLK Jr Blvd
Portland, OR 97212-1111 - Phone
- (503) 288-8066
- Fax
- (503) 288-8168
- NPI assigned
- Nov 3, 2015
- Last updated
- Nov 3, 2015
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | M6584 | OR | Primary |
Addresses
Primary practice location
3716 NE MLK Jr Blvd
Portland, OR 97212-1111
Mailing address
14600 NW Cornell Rd
Portland, OR 97229-5442
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M6584 | OR | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446508800000",
"number": "1316310063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14600 NW CORNELL RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972295442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3716 NE MLK JR BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972121111",
"telephone_number": "503-288-8066",
"fax_number": "503-288-8168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JILLIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-03",
"last_updated": "2015-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OR",
"license": "M6584",
"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 Nov 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.