1780955823 NPI number — JAKOB WILSON KLEINT MSW, LCSW

Table of content: JAKOB WILSON KLEINT MSW, LCSW (NPI 1780955823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780955823 NPI number — JAKOB WILSON KLEINT MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEINT
Provider First Name:
JAKOB
Provider Middle Name:
WILSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEINT
Provider Other First Name:
JAKE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780955823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8235 SW OLESON RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-6998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-272-7211
Provider Business Mailing Address Fax Number:
503-719-6930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8235 SW OLESON RD STE B&C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-6998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-272-7211
Provider Business Practice Location Address Fax Number:
503-719-6930
Provider Enumeration Date:
01/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  L8457 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)