Provider Demographics
NPI:1164642203
Name:JESME, TAMARA KAY (PSYD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:JESME
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 1:975 SE SANDY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2498
Mailing Address - Country:US
Mailing Address - Phone:503-805-9392
Mailing Address - Fax:
Practice Address - Street 1:975 SE SANDY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2498
Practice Address - Country:US
Practice Address - Phone:503-805-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical