IndividualActive
Johnathon Jacobsen
NPI 1699363143 · Behavior Technician · Gresham, OR
Provider details
- NPI number
- 1699363143
- Entity type
- Individual
- Primary specialty
- Behavior TechnicianBehavioral Health & Social Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 10212054 (OR)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
912 Ne Kelly Ave # 100c
Gresham, OR 97030-5629
Phone: (503) 912-5502
Street-level locationGet directions
Mailing address
4920 Ne Glisan St Apt 215
Portland, OR 97213-2964
Registry dates
- Enumerated
- 2021-01-08
- Last updated
- 2021-01-08
- Certified
- 2021-01-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.