Individual
JESSE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
443 NE KNOTT ST, PORTLAND, OR 97212-3108
(503) 504-0941
Mailing address
443 NE KNOTT ST, PORTLAND, OR 97212-3108
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/22/2013
Last updated
05/22/2013
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