Jensine Peterson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L11844 Issued in OR

Practice address

4101 NE Division St
Gresham, OR 97030-4617

Phone

(503) 666-6575

NPI assigned

Jan 10, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Telecare Mental Health Services of Oregon, Inc.Group PAC ID 1557460524, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Telecare Mental Health Services of Oregon, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gresham, OR
  • NPI 1386767176
  Medicare reassignment Care Compare group NPD
• Telecare Mental Health Services of Oregon, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Portland, OR
  • NPI 1659453686
  NPD
• Telecare Mental Health Services of Oregon, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Gresham, OR
  • NPI 1740378371
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1427868546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 SE BELMONT ST APT 3",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151772",
            "telephone_number": "608-469-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 NE DIVISION ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970304617",
            "telephone_number": "503-666-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JENSINE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-10",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L11844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan James Perry, CADC II
• Kristen Peterca, MA, LPC, NCC
• Bethany Helaina Peterman, LPC CADCIII
• Krystal Peters
• Traci Lynn Peters, PHARMD
• Pamela Diane Peterson, LMT
• Aaron Petrarca
• David Pettit
• Erin Petty
• Maci Pfaffenberger, PA-C

• Clinical Social Worker in Gresham, OR
• Providers in Gresham, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.