MEDICARE: JESSICA LORRAINE SAUCEDO LCSW

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	104100000X	Social Worker	ASW64926	CA
2	1041C0700X	Clinical Social Worker	86703	CA

General Provider Information

NPI Number	:	1760820427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LORRAINE SAUCEDO LCSW

Provider Business Mailing Address
First Line	:	2414 W OLD PAINT TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-6608
Country	:	US
Telephone Number	:	844-385-3747
Fax Number	:	480-462-2801

Provider Business Practice Location Address
First Line	:	2820 N GLASSFORD HILL RD STE 108
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2256
Country	:	US
Telephone Number	:	844-385-3747
Fax Number	:	480-462-2801

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

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	04/09/2025

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