Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | L8221 | OR |
N | 1041C0700X | Clinical Social Worker | LW60993977 | WA |
N | 1041S0200X | School Social Worker | 431736 | OR |
NPI | 1003245242 |
---|---|
Provider Name | Mr. Jes Dimas |
First Address | Mcminnville, OR 97128-1147 |
Second Address | Mcminnville, OR 97128-4627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2013 |
Last Update Date | 20/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500688776 | (05) | OR |