Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Johnathon Michael Jacobsen

Individual provider Behavior Technician · NPI 1699363143

Johnathon Michael Jacobsen is a Behavior Technician in Gresham, Oregon. Licensed in Oregon. Registered with an NPI since 2021.

Licensed in
OR
In the registry since
2021

Practice location Address checks out

912 NE Kelly Ave # 100C
Gresham, OR 97030-5629
Phone: (503) 912-5502
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X · Licence 10212054 (OR)

Record details

NPI number1699363143
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 8, 2021
Last updated in NPPESJanuary 8, 2021
Certification dateJanuary 7, 2021
Mailing address4920 Ne Glisan St Apt 215, Portland, OR 97213-2964

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