Jesse Wayne Coburn, LSCW, CADC II, SUDP is a medicare enrolled "Social Worker - Clinical" provider in Portland, Oregon. His current practice location is
5257 Ne Mlk Jr Blvd Ste 201, Portland, Oregon. You can reach out to his office (for appointments etc.) via phone at
(503) 954-2077.
Jesse Wayne Coburn is licensed to practice in Oregon (license number L10830) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1902463086.
Healthcare Provider's Profile
| Full Name | Jesse Wayne Coburn |
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| Gender | Male |
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| Speciality | |
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| Experience | Years |
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| Location | 5257 Ne Mlk Jr Blvd Ste 201, Portland, Oregon |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Jesse Wayne Coburn attended and graduated from in
NPI Data:
- NPI Number: 1902463086
- Provider Enumeration Date: 05/23/2019
- Last Update Date: 04/24/2025
Medicare PECOS Information:
- PECOS PAC ID:
- Enrollment ID:
Medical Identifiers
Medical identifiers for Jesse Wayne Coburn such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1902463086 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CP61374175 (Washington) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 19-10-32 (Oregon) | Secondary |
| 1041C0700X | Social Worker - Clinical | LW61327515 (Washington) | Secondary |
| 1041C0700X | Social Worker - Clinical | L10830 (Oregon) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jesse Wayne Coburn is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jesse Wayne Coburn, LSCW, CADC II, SUDP
371 E Cronquist Rd,
Allyn, WA 98524-8745
Ph: (208) 404-1501 | Jesse Wayne Coburn, LSCW, CADC II, SUDP
5257 Ne Mlk Jr Blvd Ste 201,
Portland, OR 97211-3283
Ph: (503) 954-2077 |
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