Provider Demographics
NPI:1891522595
Name:BRADBURN, JESSICA ROCHELLE (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROCHELLE
Last Name:BRADBURN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MONROE PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8866
Mailing Address - Country:US
Mailing Address - Phone:503-583-2365
Mailing Address - Fax:
Practice Address - Street 1:9 MONROE PKWY STE 205
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8864
Practice Address - Country:US
Practice Address - Phone:503-583-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health