Provider Demographics
NPI:1952589350
Name:JESKE, ROBERT WALTER
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:JESKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14628 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3323
Mailing Address - Country:US
Mailing Address - Phone:760-948-5623
Mailing Address - Fax:760-948-8244
Practice Address - Street 1:14628 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3323
Practice Address - Country:US
Practice Address - Phone:760-948-5623
Practice Address - Fax:760-948-8244
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor