Provider Demographics
NPI:1376671750
Name:WEEDMAN, JONATHAN KARL (LPC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:KARL
Last Name:WEEDMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SW MORRISON ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2234
Mailing Address - Country:US
Mailing Address - Phone:503-913-8603
Mailing Address - Fax:503-224-0395
Practice Address - Street 1:1130 SW MORRISON ST
Practice Address - Street 2:SUITE 410
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2234
Practice Address - Country:US
Practice Address - Phone:503-913-8603
Practice Address - Fax:503-224-0395
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101YP2500XOtherLPC