Individual provider · Type 1 NPI

Jesse Wayne Coburn, LSCW, CADC II, SUDP

Clinical Social Worker · Portland, OR

NPI number 1902463086 Active

Practice location

5257 NE Mlk Jr Blvd Ste 201
Portland, OR 97211-3283

Call (503) 954-2077 Map

Fax (503) 954-2089

Mailing address

50 12th Ave
Milton, WA 98354-6500

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor 101YA0400X19-10-32 (OR)
Clinical Social Worker 1041C0700XL10830 (OR)
Clinical Social Worker Primary 1041C0700XLW61327515 (WA)
Addiction (Substance Use Disorder) Counselor 101YA0400XCP61374175 (WA)
Clinical Social Worker 1041C0700XL18030 (OR)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1902463086

Jesse Wayne Coburn, LSCW, CADC II, SUDP's National Provider Identifier is 1902463086, issued on May 23, 2019. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Portland, OR. The record was last updated on Jun 24, 2026.