MEDICARE: MS. DENISE LYNN NEJEDLO MSW

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	1041C0700X	Clinical Social Worker	1845	OR

General Provider Information

NPI Number	:	1518180355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE LYNN NEJEDLO MSW

Provider Business Mailing Address
First Line	:	3886 COMMERCIAL ST SE
Second Line	:	SUITE 202
City	:	SALEM
State	:	OR
Zip	:	97302-3835
Country	:	US
Telephone Number	:	503-999-2930
Fax Number	:

Provider Business Practice Location Address
First Line	:	3886 COMMERCIAL ST SE
Second Line	:	SUITE 202
City	:	SALEM
State	:	OR
Zip	:	97302-3835
Country	:	US
Telephone Number	:	503-999-2930
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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