Provider Demographics
NPI:1063828259
Name:MENEN JESSING, SUSAN (SUE) MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN (SUE)
Middle Name:MARIA
Last Name:MENEN JESSING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 W ANCHOR AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1601
Mailing Address - Country:US
Mailing Address - Phone:541-505-6160
Mailing Address - Fax:866-203-1903
Practice Address - Street 1:98 W ANCHOR AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1601
Practice Address - Country:US
Practice Address - Phone:541-505-6160
Practice Address - Fax:866-203-1903
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR132050103TS0200X
OR10411871103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool