Individual provider Active NPI

Charisma Jefferson

  • Clinical Social Worker
  • Cornelius, OR
National Provider Identifier
1003741430
Registry record updated Jun 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1151 N Adair St
Cornelius, OR 97113-8900
Phone
(503) 359-5564
NPI assigned
Jun 16, 2026
Last updated
Jun 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

1151 N Adair St
Cornelius, OR 97113-8900

Mailing address

18205 NW Bronson Rd Apt F6
Portland, OR 97229-3468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1781568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1003741430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18205 NW BRONSON RD APT F6",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972293468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 N ADAIR ST",
            "city": "CORNELIUS",
            "state": "OR",
            "postal_code": "971138900",
            "telephone_number": "503-359-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "CHARISMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-16",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornelius, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.