MEDICARE: JACY SAUCEDO

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	1041C0700X	Clinical Social Worker	L11425	OR

General Provider Information

NPI Number	:	1558791871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACY SAUCEDO

Provider Business Mailing Address
First Line	:	14781 SW 109TH AVE APT 3
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97224-3223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14781 SW 109TH AVE APT 3
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97224-3223
Country	:	US
Telephone Number	:	503-235-0021
Fax Number	:

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

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	09/05/2024

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Directions to “ JACY SAUCEDO ” Practice Location

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