Provider Demographics
NPI:1023441326
Name:WESLEY REIBACH, JESSAMYN
Entity type:Individual
Prefix:MS
First Name:JESSAMYN
Middle Name:
Last Name:WESLEY REIBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JESSAMYN
Other - Middle Name:
Other - Last Name:WESLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 11571
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-0571
Mailing Address - Country:US
Mailing Address - Phone:971-238-7913
Mailing Address - Fax:
Practice Address - Street 1:36 NE 50TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2906
Practice Address - Country:US
Practice Address - Phone:712-387-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-10
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health