Jessica Padilla, CADCII QMHAII PSS CH

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

22-II-20220 Issued in OR

Practice address

3031 NE Stephens St
Roseburg, OR 97470-6237

Phone

(458) 803-4057

NPI assigned

Jan 4, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other names 1

• Jessica Reanne Bonacker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JCEJBD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Umpqua Health Newton Creek, LLC

  • Rural Health Clinic/Center
  • Roseburg, OR
  • NPI 1174066278
  NPD

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

{
    "created_epoch": "1388793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1164843470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1700",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700414",
            "telephone_number": "541-229-7038",
            "fax_number": "541-464-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 NE STEPHENS ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974706237",
            "telephone_number": "458-803-4057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PADILLA",
        "first_name": "JESSICA",
        "credential": "CADCII QMHAII PSS CH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-04",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "THW000002914",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OR",
            "license": "THW000002914",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "22-QMHA-II-000058",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "22-II-20220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BONACKER",
            "middle_name": "REANNE",
            "credential": "QMHA, PSS, CHW, BS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David E. Owens, MD
• Markelle Owens
• Janice Owings, FNP
• Pacific Crest Chiropractic and Wellness Center PC
• Pacific Healthcare Services, P.C.
• Sarah A. Paeth, CNM
• Rebecca Michelle Page, M.S.
• Tiffany A Pagel
• Lauralen Elise Pahls Perham, LMFT
• Bhanu Prasad Paladugu, MD

• Addiction (Substance Use Disorder) Counselor in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.