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NPI Code Detail

MEDICARE: MS. JACQUELYN MICHELLE SERRANO LCSW, CADC I

MEDICARE: MS. JACQUELYN MICHELLE SERRANO LCSW, 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
11041C0700XClinical Social WorkerL7940OR

General Provider Information

NPI Number : 1639577133
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELYN MICHELLE SERRANO LCSW, CADC I
Provider Business Mailing Address
First Line : 7105 N DELAWARE AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97217-5703
Country : US
Telephone Number : 951-733-6979
Fax Number :
Provider Business Practice Location Address
First Line : 121 E HISTORIC COLUMBIA RIVER HWY
Second Line :
City : TROUTDALE
State : OR
Zip : 97060-2006
Country : US
Telephone Number : 971-293-9237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2014
Last Update Date : 02/24/2026

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Directions to “ MS. JACQUELYN MICHELLE SERRANO LCSW, CADC I” Practice Location

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