Provider Demographics
NPI:1124258769
Name:FEIMOEFIAFI, JAYOTTA JEFFERSON
Entity type:Individual
Prefix:
First Name:JAYOTTA
Middle Name:JEFFERSON
Last Name:FEIMOEFIAFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N VANCOUVER AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1643
Mailing Address - Country:US
Mailing Address - Phone:503-249-8851
Mailing Address - Fax:
Practice Address - Street 1:2800 N VANCOUVER AVE STE 118
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1643
Practice Address - Country:US
Practice Address - Phone:503-249-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR40171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical