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NPI Code Detail

MEDICARE: NAOMI MIMNAUGH

MEDICARE: NAOMI MIMNAUGH
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
1101YP2500XProfessional CounselorR7476OR

General Provider Information

NPI Number : 1689240939
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAOMI MIMNAUGH
Provider Business Mailing Address
First Line : 8545 SW JOELLE CT
Second Line :
City : TIGARD
State : OR
Zip : 97223-2427
Country : US
Telephone Number : 503-830-2044
Fax Number :
Provider Business Practice Location Address
First Line : 18765 SW BOONES FERRY RD
Second Line :
City : TUALATIN
State : OR
Zip : 97062-8496
Country : US
Telephone Number : 503-612-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2021
Last Update Date : 12/23/2025

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Directions to “ NAOMI MIMNAUGH ” Practice Location

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