Provider Demographics
NPI:1306987573
Name:NESTLER, JESSICA (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:NESTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3302
Mailing Address - Country:US
Mailing Address - Phone:503-351-2671
Mailing Address - Fax:503-813-7795
Practice Address - Street 1:3550 SE WOODWARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1552
Practice Address - Country:US
Practice Address - Phone:503-351-2671
Practice Address - Fax:503-813-7795
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0143001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical