Provider Demographics
NPI:1215511654
Name:GASPER, JESHURUN
Entity type:Individual
Prefix:
First Name:JESHURUN
Middle Name:
Last Name:GASPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SW GRIFFITH DR STE 157
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2977
Mailing Address - Country:US
Mailing Address - Phone:503-444-8230
Mailing Address - Fax:503-295-4036
Practice Address - Street 1:4900 SW GRIFFITH DR STE 157
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2977
Practice Address - Country:US
Practice Address - Phone:503-444-8230
Practice Address - Fax:503-295-4036
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health