Provider Demographics
NPI:1609304138
Name:GUNDERSON, JESSICA (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JESS
Other - Middle Name:
Other - Last Name:GUNDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:7400 SW BARNES RD APT 913
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-7032
Mailing Address - Country:US
Mailing Address - Phone:503-420-3858
Mailing Address - Fax:
Practice Address - Street 1:7400 SW BARNES RD APT 913
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-7032
Practice Address - Country:US
Practice Address - Phone:503-420-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist