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NPI Code Detail

MEDICARE: JESSICA CARMEN HARRISON BS, CADC I

MEDICARE: JESSICA CARMEN HARRISON BS, CADC I
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
1101Y00000XCounselorQMHAOR
2101YA0400XAddiction (Substance Use Disorder) Counselor105-11-25OR
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1417094129
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA CARMEN HARRISON BS, CADC I
Provider Business Mailing Address
First Line : 2830 SE 127TH AVE
Second Line : A233
City : PORTLAND
State : OR
Zip : 97236-3183
Country : US
Telephone Number : 503-872-0480
Fax Number : 503-872-0481
Provider Business Practice Location Address
First Line : 9268 SE CLINTON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97266-1456
Country : US
Telephone Number : 503-872-0480
Fax Number : 503-872-0481
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 09/11/2025

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