Mary Smidt Jernstrom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2035 Issued in OR

Practice address

2875 NW Stucki Ave
Hillsboro, OR 97124-5806

Phone

(971) 310-1000

Fax

(503) 571-2204

NPI assigned

May 31, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369958400000",
    "number": "1659718617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 NW STUCKI AVE",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245806",
            "telephone_number": "971-310-1000",
            "fax_number": "503-571-2204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 NW STUCKI AVE",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245806",
            "telephone_number": "971-310-1000",
            "fax_number": "503-571-2204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERNSTROM",
        "first_name": "MARY",
        "middle_name": "SMIDT",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2013-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "2035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer a Scott MD LLC
• Rachel Ann Jennings, CCC-SLP
• Parker Jensen, PT
• Jeremy M Lake, MD LLC
• Laura Jermain
• Christine Elizabeth Jeschke
• Jack Ce Ji, DO
• Jiating Jiang, MD
• Joy Ataly Jimenez-Lopez
• Bianey Jimenez

• Clinical Social Worker in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; 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.