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NPI Code Detail

MEDICARE: MR. GARY LEE PFENNING MSW

MEDICARE: MR. GARY LEE PFENNING MSW
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1780749754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY LEE PFENNING MSW
Provider Business Mailing Address
First Line : 1544 MADELYN AVE SE
Second Line :
City : SALEM
State : OR
Zip : 97306-3554
Country : US
Telephone Number : 503-391-4293
Fax Number :
Provider Business Practice Location Address
First Line : 1049 OAK ST SE
Second Line :
City : SALEM
State : OR
Zip : 97301-4018
Country : US
Telephone Number : 503-585-4949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 07/08/2007

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