Individual ProviderJessica SmithCounselorBehavioral Health & Social Service ProvidersPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553(503) 258-4200PECOS EnrollmentBased on the most recent information from CMS, provider Jessica Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1184009623Provider TypeIndividualFull NameSmith, JessicaCredentialMSGenderFemaleSole ProprietorYesEnumeration Date7/27/2015Last Updated3/11/2016Contact InformationPractice LocationPractice Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxMailing LocationMailing Address11035 NE Sandy Blvd, Portland, OR 97220-2553Phone(503) 258-4200FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer