| Doctor Name: | FRED JESNEN |
| NPI Number: | 1316076078 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CADC |
| License Number: | |
| Business Practice Address: | 600 S 2nd St Central Point, OR - 975022704 |
| Business Phone Number: | 5417894000 |
| Business Fax Number: | 5417894023 |
| Mailing Address: | 100 E Main St, Suite C MEDFORD |
| State: | OR |
| Postal Code: | 975016041 |
| Phone Number: | 5417895526 |
| Fax Number: | 5417895203 |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |