Healthcare Provider Details

I. General information

NPI: 1164192910
Provider Name (Legal Business Name): JESSICA PADNICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST # 7703
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

2108 N ST # 7703
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 971-361-6302
  • Fax:
Mailing address:
  • Phone: 971-361-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11516
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: