Provider Demographics
NPI:1457850117
Name:MORTENSEN, ESTHER LOUISE
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:LOUISE
Last Name:MORTENSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1787
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0261
Mailing Address - Country:US
Mailing Address - Phone:541-500-8655
Mailing Address - Fax:800-433-1396
Practice Address - Street 1:485 E MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2162
Practice Address - Country:US
Practice Address - Phone:541-816-6700
Practice Address - Fax:800-433-1396
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health