Healthcare Provider Details

I. General information

NPI: 1003465022
Provider Name (Legal Business Name): JESSICA MARCEV MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 NE TWIN KNOLLS DR STE 103
BEND OR
97701-4895
US

IV. Provider business mailing address

1334 NE PURCELL BLVD APT 3
BEND OR
97701-6332
US

V. Phone/Fax

Practice location:
  • Phone: 541-205-9235
  • Fax:
Mailing address:
  • Phone: 804-564-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: