Active NPI
Jill Ashley Davidson, PSY.D
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1841508553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2247
- Practice address
- 1130 SW Morrison St
Suite 619
Portland, OR 97205-2234 - Phone
- (503) 313-0028
- NPI assigned
- Sep 15, 2010
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2247 | OR | Primary |
Addresses
Primary practice location
1130 SW Morrison St
Suite 619
Portland, OR 97205-2234
Mailing address
1130 SW Morrison St
Suite 619
Portland, OR 97205-2234
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 |
|---|---|---|---|
| 2247 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Collective Care Clinic, LLC | Past | Accepting new patients | |
| Portland Anxiety Clinic | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Cognitive & Behavioral Psychologist
- Portland, OR
- NPI 1780221499
-
- Mental Health Counselor
- Portland, OR
- NPI 1033692991
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366761600000",
"number": "1841508553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1130 SW MORRISON ST",
"address_2": "SUITE 619",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 SW MORRISON ST",
"address_2": "SUITE 619",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052234",
"telephone_number": "503-313-0028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "JILL",
"middle_name": "ASHLEY",
"name_prefix": "Mrs.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-15",
"last_updated": "2013-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2247",
"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 Apr 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.