MEDICARE: JESSICA S HUNTLEY MSW, LCSW

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	1041C0700X	Clinical Social Worker	L8627	OR
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750733093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA S HUNTLEY MSW, LCSW

Provider Business Mailing Address
First Line	:	1109 SHAMROCK DR SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3449
Country	:	US
Telephone Number	:	503-383-9110
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 SHAMROCK DR SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3449
Country	:	US
Telephone Number	:	503-383-9110
Fax Number	:

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	06/08/2026

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