MEDICARE: VICTORIA FELLINGHAM LCSW

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	L4440	OR

General Provider Information

NPI Number	:	1639212632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA FELLINGHAM LCSW

Provider Business Mailing Address
First Line	:	16144 SE HAPPY VALLEY TOWN CENTER DR STE 210
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-4257
Country	:	US
Telephone Number	:	503-486-7040
Fax Number	:	503-658-3377

Provider Business Practice Location Address
First Line	:	16144 SE HAPPY VALLEY TOWN CENTER DR STE 210
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-4257
Country	:	US
Telephone Number	:	503-486-7040
Fax Number	:	503-658-3377

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	01/26/2026

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