Provider Demographics
NPI:1720394315
Name:JESKE, MEGAN WEBER (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:WEBER
Last Name:JESKE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NE BROADWAY
Mailing Address - Street 2:319A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1569
Mailing Address - Country:US
Mailing Address - Phone:503-753-1184
Mailing Address - Fax:503-512-5230
Practice Address - Street 1:2512 SE 25TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2075
Practice Address - Country:US
Practice Address - Phone:503-985-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional