Healthcare Provider Details

I. General information

NPI: 1447164157
Provider Name (Legal Business Name): RANDALL YESMONT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16365 TWIN OAKS DRIVE UNIT 200
BEAVERTON OR
97006
US

IV. Provider business mailing address

8035 SW THORN ST
TIGARD OR
97223-8436
US

V. Phone/Fax

Practice location:
  • Phone: 503-828-3402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: