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NPI Code Detail

MEDICARE: JODIE QUEVEDO

MEDICARE: JODIE QUEVEDO
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
1101YM0800XMental Health CounselorOR
2175T00000XPeer Specialist
3171M00000XCase Manager/Care Coordinator
4101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1962158717
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODIE QUEVEDO
Provider Business Mailing Address
First Line : 1060 WEBBER ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3749
Country : US
Telephone Number : 541-296-5452
Fax Number :
Provider Business Practice Location Address
First Line : 1060 WEBBER ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3749
Country : US
Telephone Number : 541-296-5452
Fax Number : 541-296-9418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2022
Last Update Date : 01/13/2026

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Directions to “ JODIE QUEVEDO ” Practice Location

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