MEDICARE: NICHOLAS BRYCE WOODS 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	11080	OR

General Provider Information

NPI Number	:	1699126011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS BRYCE WOODS LCSW

Provider Business Mailing Address
First Line	:	5441 S MACADAM AVE STE N
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3822
Country	:	US
Telephone Number	:	541-250-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5441 S MACADAM AVE STE N
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3822
Country	:	US
Telephone Number	:	541-250-4060
Fax Number	:

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

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/07/2026

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