Provider Demographics
NPI:1043726508
Name:YBARRA, JENNIFER BERGMANS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BERGMANS
Last Name:YBARRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:BERGMANS
Other - Last Name:BERGMANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9620 NE TANASBOURNE DR STE 300-75
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7843
Mailing Address - Country:US
Mailing Address - Phone:503-481-3512
Mailing Address - Fax:
Practice Address - Street 1:9620 NE TANASBOURNE DR STE 300-75
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7843
Practice Address - Country:US
Practice Address - Phone:503-481-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL75991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500740982Medicaid