MEDICARE: YANA PONOMAROVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1265268197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANA PONOMAROVA

Provider Business Mailing Address
First Line	:	14101 SE SUMMERFIELD LOOP
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-5394
Country	:	US
Telephone Number	:	971-340-7817
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 SE 99TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97216-2449
Country	:	US
Telephone Number	:	971-271-6512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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Directions to “ YANA PONOMAROVA ” Practice Location

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