MEDICARE: BRIDGET MARIE HERRIN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1750420238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET MARIE HERRIN

Provider Business Mailing Address
First Line	:	6536 NW WENMARIE DR
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-1590
Country	:	US
Telephone Number	:	503-547-3022
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 SW WASHINGTON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2327
Country	:	US
Telephone Number	:	503-535-1150
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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