Provider Demographics
NPI:1528438363
Name:WALTHER, JESSICA (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WALTHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 NE HWY 20
Mailing Address - Street 2:STE 610 PMB#: 365
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-527-2599
Mailing Address - Fax:
Practice Address - Street 1:2260 NE HWY 20
Practice Address - Street 2:STE 610 PMB#: 365
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1557
Practice Address - Country:US
Practice Address - Phone:541-527-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional