Active NPI
Jessica Ellen Wilson, M.S., PSY.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1841675709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2617
- Practice address
- 4004 SE Woodstock Blvd
Portland, OR 97202-7662 - Phone
- (503) 777-0444
- Fax
- (503) 777-0445
- NPI assigned
- Jul 21, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | 2617 | OR | Primary |
Addresses
Primary practice location
4004 SE Woodstock Blvd
Portland, OR 97202-7662
Mailing address
10115 SE Bell Ave
Milwaukie, OR 97222-2533
Phone (702) 540-1819
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447200000000",
"number": "1841675709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10115 SE BELL AVE",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972222533",
"telephone_number": "702-540-1819",
"fax_number": "530-777-0445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4004 SE WOODSTOCK BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972027662",
"telephone_number": "503-777-0444",
"fax_number": "503-777-0445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JESSICA",
"middle_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "M.S., PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-21",
"last_updated": "2015-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2617",
"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 11, 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.