Provider Demographics
NPI:1225701436
Name:RAMSEY, JESS WILLIAM (CADC-R)
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:WILLIAM
Last Name:RAMSEY
Suffix:
Gender:M
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:SILETZ
Mailing Address - State:OR
Mailing Address - Zip Code:97380-0320
Mailing Address - Country:US
Mailing Address - Phone:541-819-4021
Mailing Address - Fax:
Practice Address - Street 1:200 GWEE SHUT RD
Practice Address - Street 2:
Practice Address - City:SILETZ
Practice Address - State:OR
Practice Address - Zip Code:97380-2036
Practice Address - Country:US
Practice Address - Phone:541-444-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-21-946101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)