MEDICARE: JENNIFER J PORTER PPS CREDENTIAL

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
1	101YS0200X	School Counselor	240294748	CA

General Provider Information

NPI Number	:	1598644239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER J PORTER PPS CREDENTIAL

Provider Business Mailing Address
First Line	:	1460 ORANGE ST
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-4113
Country	:	US
Telephone Number	:	530-567-9728
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 ORANGE ST
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-4113
Country	:	US
Telephone Number	:	530-567-9728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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