Provider Demographics
NPI:1700966926
Name:VALEN, JONATHAN JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JOSEPH
Last Name:VALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 SW 6TH AVE
Mailing Address - Street 2:STE 602
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1533
Mailing Address - Country:US
Mailing Address - Phone:503-223-5537
Mailing Address - Fax:503-223-5584
Practice Address - Street 1:506 SW 6TH AVE
Practice Address - Street 2:STE 602
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1533
Practice Address - Country:US
Practice Address - Phone:503-223-5537
Practice Address - Fax:503-223-5584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD225562084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR164936Medicaid