MEDICARE: JONTAE MALIK HARDAWAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	R12434	OR

General Provider Information

NPI Number	:	1891627659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONTAE MALIK HARDAWAY

Provider Business Mailing Address
First Line	:	4850 SE WOODSTOCK BLVD APT 541
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6143
Country	:	US
Telephone Number	:	503-701-7079
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 SE WOODSTOCK BLVD APT 541
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6143
Country	:	US
Telephone Number	:	503-701-7079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

Similar Medicare Providers

1811884844 — TY WARNER
Practice Location Address:

4850 SE WOODSTOCK BLVD APT 541
PORTLAND, OR
97206-6143

Practice Phone: 509-981-2224
Practice Fax:

1962442368 — TRACY CARDELLI R.D.
Practice Location Address:

39 WALLACE AVE
SO PORTLAND, ME
04106-6143

Practice Phone: 207-761-0650
Practice Fax: 207-761-8198

1518082577 — KALLIOPE VARAKLIS MD
Practice Location Address:

39 WALLACE AVE
SOUTH PORTLAND, ME
04106-6143

Practice Phone: 207-761-0650
Practice Fax: 207-761-8198

1033669759 — MOLLY NEWMAN PT
Practice Location Address:

6143 SW VIRGINIA AVE
PORTLAND, OR
97239-3600

Practice Phone: 503-901-1796
Practice Fax:

1487586509 — MARIA ISABEL CASTRO-MENDOZA
Practice Location Address:

6536 SE DUKE ST
PORTLAND, OR
97206-6665

Practice Phone: 503-547-4924
Practice Fax:

1609708759 — ELLEN BIESEMEYER
Practice Location Address:

6536 SE DUKE ST # 2
PORTLAND, OR
97206-6665

Practice Phone: 503-457-4924
Practice Fax:

Directions to “ JONTAE MALIK HARDAWAY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.