Provider Demographics
NPI:1174618433
Name:JARCHO, KORI M (LCSW)
Entity type:Individual
Prefix:MS
First Name:KORI
Middle Name:M
Last Name:JARCHO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NE 8TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7317
Mailing Address - Country:US
Mailing Address - Phone:503-988-5115
Mailing Address - Fax:503-988-5185
Practice Address - Street 1:421 SW OAK ST
Practice Address - Street 2:210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1817
Practice Address - Country:US
Practice Address - Phone:503-988-3663
Practice Address - Fax:503-988-4098
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL19601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR164936Medicaid