Provider Demographics
NPI:1144585332
Name:HANSEN, JESSICA J (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:DUHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0151
Mailing Address - Country:US
Mailing Address - Phone:541-375-0314
Mailing Address - Fax:541-896-4120
Practice Address - Street 1:1614 SE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4000
Practice Address - Country:US
Practice Address - Phone:541-375-0314
Practice Address - Fax:541-440-3554
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646807Medicaid