Healthcare Provider Details

I. General information

NPI: 1174034110
Provider Name (Legal Business Name): JESSICA CASAROTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA PEMBERTON

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 NE MAUZEY CT
HILLSBORO OR
97124-9092
US

IV. Provider business mailing address

8280 NE MAUZEY CT
HILLSBORO OR
97124-9092
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9531
  • Fax: 503-531-3841
Mailing address:
  • Phone: 503-439-9531
  • Fax: 503-531-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8188
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: