Active NPI
Tamera Jessen-Iverson
- Behavior Analyst
- Salem, OR
National Provider Identifier
1245591437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 109
- Practice address
- 742 Hawthorne Ave NE
Salem, OR 97301-4675 - Phone
- (503) 559-3555
- NPI assigned
- Jun 4, 2012
- Last updated
- Jun 4, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 109 | OR | Primary |
Addresses
Primary practice location
742 Hawthorne Ave NE
Salem, OR 97301-4675
Mailing address
PO Box 13459
Salem, OR 97309-1459
Phone (503) 559-3555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 023008 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109 | OR | MD | General Care Registered Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338768000000",
"number": "1245591437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13459",
"city": "SALEM",
"state": "OR",
"postal_code": "973091459",
"telephone_number": "503-559-3555",
"fax_number": "503-769-3114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "742 HAWTHORNE AVE NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973014675",
"telephone_number": "503-559-3555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JESSEN-IVERSON",
"first_name": "TAMERA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-04",
"last_updated": "2012-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OR",
"license": "109",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "023008",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.