Provider Demographics
NPI:1427316793
Name:ETCHEBERRY, JESSICA JOANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JOANNE
Last Name:ETCHEBERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:JOANNE
Other - Last Name:PHILLIPPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, QMHP
Mailing Address - Street 1:8855 SW HOLLY LANE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8792
Mailing Address - Country:US
Mailing Address - Phone:971-319-1613
Mailing Address - Fax:
Practice Address - Street 1:8855 SW HOLLY LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8792
Practice Address - Country:US
Practice Address - Phone:971-319-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health