MEDICARE: CLARE FOGARTY

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	150.114005	IL

General Provider Information

NPI Number	:	1548135023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARE FOGARTY

Provider Business Mailing Address
First Line	:	5918 NW NECANICUM WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-1050
Country	:	US
Telephone Number	:	503-707-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	5918 NW NECANICUM WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-1050
Country	:	US
Telephone Number	:	503-707-1972
Fax Number	:

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

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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Directions to “ CLARE FOGARTY ” Practice Location

Language	Start Address	Practice Location

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