Individual
JACOB REESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
11211 SE 82ND AVE STE 0, PORTLAND, OR 97086-7641
(503) 722-6200
(503) 722-6545
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L8065
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500710078
—
OR
Enumeration date
10/26/2015
Last updated
07/25/2019
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