Provider Demographics
NPI:1255131009
Name:PORTE, JESSICA KIMBERLY (CRM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KIMBERLY
Last Name:PORTE
Suffix:
Gender:
Credentials:CRM
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 16062
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0062
Mailing Address - Country:US
Mailing Address - Phone:971-570-7300
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 16062
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97292-0062
Practice Address - Country:US
Practice Address - Phone:971-570-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist