Provider Demographics
NPI:1548284565
Name:NORMAN, JANE THARPE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:THARPE
Last Name:NORMAN
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 1:17051 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5871
Mailing Address - Country:US
Mailing Address - Phone:503-757-2722
Mailing Address - Fax:503-636-2129
Practice Address - Street 1:17051 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-5871
Practice Address - Country:US
Practice Address - Phone:503-757-2722
Practice Address - Fax:503-636-2129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL1253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130501Medicare ID - Type UnspecifiedLCSW PROVIDER