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NPI Code Detail

MEDICARE: JESSICA SIMONES

MEDICARE: JESSICA SIMONES
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
1101YA0400XAddiction (Substance Use Disorder) CounselorOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255882775
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SIMONES
Provider Business Mailing Address
First Line : 1027 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1328
Country : US
Telephone Number : 503-239-8400
Fax Number : 503-239-8406
Provider Business Practice Location Address
First Line : 10362 SW MCDONALD ST
Second Line :
City : TIGARD
State : OR
Zip : 97224-4863
Country : US
Telephone Number : 503-624-0312
Fax Number : 503-639-3973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2016
Last Update Date : 10/19/2016

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