MEDICARE: JEFFREY J GRASSER LPC

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	327	AK

General Provider Information

NPI Number	:	1104844075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY J GRASSER LPC

Provider Business Mailing Address
First Line	:	PO BOX 4105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-4105
Country	:	US
Telephone Number	:	866-907-1068
Fax Number	:	425-917-9141

Provider Business Practice Location Address
First Line	:	2250 S WOODWORTH LOOP
Second Line	:	SUITE 202
City	:	PALMER
State	:	AK
Zip	:	99645-7457
Country	:	US
Telephone Number	:	907-761-5800
Fax Number	:	907-761-5801

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	03/04/2016

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