Provider Demographics
NPI:1194500132
Name:SNOW, JESSICA (LPC - ASSOCIATE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SNOW
Suffix:
Gender:
Credentials:LPC - ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 SE 252ND AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7214
Mailing Address - Country:US
Mailing Address - Phone:971-998-2901
Mailing Address - Fax:
Practice Address - Street 1:1202 SE 223RD AVE # 165
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:971-404-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR10864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health