Provider Demographics
NPI:1295544989
Name:TALBOT, JASON (CRM)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:TALBOT
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12290 SW MARION ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2962
Mailing Address - Country:US
Mailing Address - Phone:609-751-1348
Mailing Address - Fax:
Practice Address - Street 1:1122 NE 122ND AVE STE A200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2083
Practice Address - Country:US
Practice Address - Phone:503-954-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112694175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist