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NPI Code Detail

MEDICARE: PAULA LYNN FOTHERGILL M.S., CADCII

MEDICARE: PAULA LYNN FOTHERGILL M.S., CADCII
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
1101Y00000XCounselor04-03-43UOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700857497
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA LYNN FOTHERGILL M.S., CADCII
Provider Business Mailing Address
First Line : 1631 SW COLUMBIA ST
Second Line : TATE TOPO / ANNEX
City : PORTLAND
State : OR
Zip : 97201-6025
Country : US
Telephone Number : 503-231-2641
Fax Number : 503-231-1654
Provider Business Practice Location Address
First Line : 1776 SW MADISON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97205-1715
Country : US
Telephone Number : 503-224-1044
Fax Number : 503-621-2235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 01/06/2016

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