MEDICARE: MS. JAZMIN CLAUDIA PORTILLO 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1942938154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAZMIN CLAUDIA PORTILLO LICSW

Provider Business Mailing Address
First Line	:	300 3RD AVE SE STE 206-02
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4619
Country	:	US
Telephone Number	:	507-906-0348
Fax Number	:	507-322-1702

Provider Business Practice Location Address
First Line	:	300 3RD AVE SE STE 206-02
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4619
Country	:	US
Telephone Number	:	507-906-0348
Fax Number	:

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	05/09/2026

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