MEDICARE: MS. JILLIAN SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1013945294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILLIAN SMITH

Provider Business Mailing Address
First Line	:	3216 NE 64TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-4526
Country	:	US
Telephone Number	:	503-332-7221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 NE COLUMBIA BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-1930
Country	:	US
Telephone Number	:	503-963-7773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	09/11/2025

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