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NPI Code Detail

MEDICARE: JERRICA HOLLY LICSW

MEDICARE: JERRICA HOLLY LICSW
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 WorkerLW61086180WA

General Provider Information

NPI Number : 1770378937
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRICA HOLLY LICSW
Provider Business Mailing Address
First Line : 6715 NE 63RD ST STE 267
Second Line :
City : VANCOUVER
State : WA
Zip : 98661-1980
Country : US
Telephone Number : 816-518-9490
Fax Number :
Provider Business Practice Location Address
First Line : 8716 E MILL PLAIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98664-2531
Country : US
Telephone Number : 360-696-5300
Fax Number : 360-729-3372
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2025
Last Update Date : 12/09/2025

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Directions to “ JERRICA HOLLY LICSW” Practice Location

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