Jacinta Anne Johnson | Portland, OR • PECOS Search

Jacinta Anne Johnson

Social Worker

Behavioral Health & Social Service Providers

3415 SE Powell Blvd, Portland, OR 97202-3371

PECOS Enrollment

Based on the most recent information from CMS, provider Jacinta Anne Johnson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1366603847
Provider Type
Individual
Full Name
Johnson, Jacinta Anne
Title
Ms.
Credential
CNA

Gender
Female
Sole Proprietor
No
Enumeration Date
6/18/2008
Last Updated
6/18/2008

Contact Information

Practice Location

3415 SE Powell Blvd, Portland, OR 97202-3371

Unlisted Fax

Mailing Location

3415 SE Powell Blvd, Portland, OR 97202-3371

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 104100000X Primary	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer