NPIMap

Individual provider Active NPI

Jesse Wayne Coburn, LSCW, CADC II, SUDP

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1902463086
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61327515 Issued in WA
Practice address
5257 NE MLK Jr Blvd Ste 201
Portland, OR 97211-3283
Phone
(503) 954-2077
Fax
(503) 954-2089
NPI assigned
May 23, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2026

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 19-10-32 OR
Clinical Social Worker 1041C0700X L10830 OR
Clinical Social Worker 1041C0700X LW61327515 WA Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X CP61374175 WA
Clinical Social Worker 1041C0700X L18030 OR

Addresses

Primary practice location

5257 NE MLK Jr Blvd Ste 201
Portland, OR 97211-3283

Mailing address

50 12TH Ave
Milton, WA 98354-6500
Phone (208) 404-1501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
89.69 of 100Reported as group
Quality
89.02
Promoting interoperability
85
Improvement activities
40
Cost
55.8

Merit-based Incentive Payment System (MIPS)

Final score
84.22 of 100Reported as group
Quality
72.08
Promoting interoperability
70
Improvement activities
40
Cost
66.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CP61374175WAMDAddiction (Substance Use Disorder) Counselor
L10830ORMDClinical Social Worker
LW61327515WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Volunteers of America Oregon Past Accepting new patients
Volunteers of America Inc. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782259200000",
    "number": "1902463086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 12TH AVE",
            "city": "MILTON",
            "state": "WA",
            "postal_code": "983546500",
            "telephone_number": "208-404-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5257 NE MLK JR BLVD STE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972113283",
            "telephone_number": "503-954-2077",
            "fax_number": "503-954-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "JESSE",
        "middle_name": "WAYNE",
        "credential": "LSCW, CADC II, SUDP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-23",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "19-10-32",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L10830",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61327515",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP61374175",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L18030",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.