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NPI Code Detail

MEDICARE: PHILLIP SQUIBB

MEDICARE: PHILLIP SQUIBB
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
11041C0700XClinical Social Worker6673OR
21041S0200XSchool Social Worker

General Provider Information

NPI Number : 1295018000
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP SQUIBB
Provider Business Mailing Address
First Line : PO BOX 62
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-0004
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1803 MAIN ST
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-2636
Country : US
Telephone Number : 541-591-4384
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2011
Last Update Date : 01/23/2026

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Directions to “ PHILLIP SQUIBB ” Practice Location

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