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NPI Code Detail

MEDICARE: LEONEL JAKOB-HAWK ESTEL CADC-R, CRM II

MEDICARE: LEONEL JAKOB-HAWK ESTEL CADC-R, CRM II
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
1101YA0400XAddiction (Substance Use Disorder) CounselorT-26-6409OR

General Provider Information

NPI Number : 1023960184
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONEL JAKOB-HAWK ESTEL CADC-R, CRM II
Provider Business Mailing Address
First Line : 1805 NE SANDY BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2884
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1805 NE SANDY BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2884
Country : US
Telephone Number : 503-647-6132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2026
Last Update Date : 02/11/2026

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