MEDICARE: EMILY TERESA PADILLA L14636

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	14636	OR

General Provider Information

NPI Number	:	1790327625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY TERESA PADILLA L14636

Provider Business Mailing Address
First Line	:	1130 NW 22ND AVE STE 320
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2970
Country	:	US
Telephone Number	:	503-295-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 NW 22ND AVE STE 320
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2970
Country	:	US
Telephone Number	:	503-295-2546
Fax Number	:

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

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	04/07/2026

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