Provider Demographics
NPI:1316668718
Name:SCHLOTT, JEREMIAH (LCSW)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:SCHLOTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1510
Mailing Address - Country:US
Mailing Address - Phone:503-459-1858
Mailing Address - Fax:
Practice Address - Street 1:10424 SE CHERRY BLOSSOM DR STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2801
Practice Address - Country:US
Practice Address - Phone:503-459-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL74641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty