Jared Robert Pettit

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

26-08-12016 Issued in OR

Practice address

380 NW 6TH Ave
Estacada, OR 97023-7713

Phone

(503) 395-0435

NPI assigned

May 7, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jared Snyder Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Teen Challenge International Pacific Northwest Centers

  • Community/Behavioral Health Agency
  • Milwaukie, OR
  • NPI 1245784222

  Addiction (Substance Use Disorder)

  NPD

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787270400000",
    "number": "1407604374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18600 SE MCLOUGHLIN BLVD",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972676723",
            "telephone_number": "503-946-3267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 NW 6TH AVE",
            "city": "ESTACADA",
            "state": "OR",
            "postal_code": "970237713",
            "telephone_number": "503-395-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "JARED",
        "middle_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-07",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CDPT.CO.70090940",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "26-08-12016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JARED",
            "last_name": "SNYDER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Northwest Medical Foundation of Tillamook
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• Oregon Trail Chiropractic LLC
• Richard L Orth, DO
• Andrea Lea Premazzi, ND
• Edward Lawrence Rambousek, D.O.
• Jonathan Rhue, D.C.
• Justin Rye
• Kelly Joanne Salusova, MS, LPC

• Addiction (Substance Use Disorder) Counselor in Estacada, OR
• Providers in Estacada, 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 Aug 21, 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.