MEDICARE: MRS. JESSICA L ESTEP CDCA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.184160	OH
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1639866759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA L ESTEP CDCA

Provider Business Mailing Address
First Line	:	3049 SOUTHFIELD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-3231
Country	:	US
Telephone Number	:	614-506-6467
Fax Number	:

Provider Business Practice Location Address
First Line	:	3049 SOUTHFIELD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-3231
Country	:	US
Telephone Number	:	614-506-6467
Fax Number	:

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

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	05/05/2023

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