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NPI Code Detail

MEDICARE: ANNIE WOODWORTH REGISTERED ASSOCIATE

MEDICARE: ANNIE WOODWORTH REGISTERED ASSOCIATE
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
1106S00000XBehavior TechnicianABA-IN-10182971OR
2101YP2500XProfessional CounselorR9123OR

General Provider Information

NPI Number : 1386151843
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNIE WOODWORTH REGISTERED ASSOCIATE
Provider Business Mailing Address
First Line : 4400 SALEM DALLAS HWY NW
Second Line :
City : SALEM
State : OR
Zip : 97304-3338
Country : US
Telephone Number : 503-991-5091
Fax Number :
Provider Business Practice Location Address
First Line : 4400 SALEM DALLAS HWY NW
Second Line :
City : SALEM
State : OR
Zip : 97304-3338
Country : US
Telephone Number : 503-991-5091
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2018
Last Update Date : 12/04/2024

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Directions to “ ANNIE WOODWORTH REGISTERED ASSOCIATE” Practice Location

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