MEDICARE: JESSICA RAE 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

General Provider Information

NPI Number	:	1881480408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RAE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1041
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97709-1041
Country	:	US
Telephone Number	:	541-203-0474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 N HWY 97
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7559
Country	:	US
Telephone Number	:	541-203-0474
Fax Number	:	541-610-1692

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

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	12/11/2025

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