MEDICARE: MR. DALE A. NADER L.C.S.W.

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	L3073	OR

General Provider Information

NPI Number	:	1588689244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE A. NADER L.C.S.W.

Provider Business Mailing Address
First Line	:	12732 SE STARK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97233-1539
Country	:	US
Telephone Number	:	503-708-9853
Fax Number	:	503-622-1381

Provider Business Practice Location Address
First Line	:	12732 SE STARK ST
Second Line	:	PLAZA 125, BUILDING G
City	:	PORTLAND
State	:	OR
Zip	:	97233-1539
Country	:	US
Telephone Number	:	503-708-9853
Fax Number	:	503-622-1381

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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