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General NPI Number Information
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NPI Number | 1699244509
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Entity Type | Individual
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Provider Name | JON JOSEPH CISNEROS PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 151 NW MONROE AVE STE 103
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City | CORVALLIS
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State | OR
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Zip | 97330-4708
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Country | US
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Telephone | 541-517-4542
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Fax |
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Provider Business Mailing Address
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Address Line | 151 NW MONROE AVE STE 103
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City | CORVALLIS
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State | OR
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Zip | 97330-4708
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Country | US
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Telephone | 541-517-4542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-1825
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3354
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License Number State | OR
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