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NPI Code Detail

MEDICARE: JESHURUN GASPER

MEDICARE: JESHURUN GASPER
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
1101YM0800XMental Health CounselorC8777OR

General Provider Information

NPI Number : 1215511654
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESHURUN GASPER
Provider Business Mailing Address
First Line : 4900 SW GRIFFITH DR STE 157
Second Line :
City : BEAVERTON
State : OR
Zip : 97005-2977
Country : US
Telephone Number : 503-444-8230
Fax Number : 503-295-4036
Provider Business Practice Location Address
First Line : 4900 SW GRIFFITH DR STE 157
Second Line :
City : BEAVERTON
State : OR
Zip : 97005-2977
Country : US
Telephone Number : 503-444-8230
Fax Number : 503-295-4036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2021
Last Update Date : 09/11/2024

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Directions to “ JESHURUN GASPER ” Practice Location

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