Provider Demographics
NPI:1255131009
Name:PORTE, JESSICA KIMBERLY (CRM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KIMBERLY
Last Name:PORTE
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 SE 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3059
Mailing Address - Country:US
Mailing Address - Phone:503-990-4821
Mailing Address - Fax:
Practice Address - Street 1:2412 SE 106TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3059
Practice Address - Country:US
Practice Address - Phone:503-990-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist