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NPI Code Detail

MEDICARE: MS. ERIN BRADSHAW LCSW

MEDICARE: MS. ERIN BRADSHAW 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
1101Y00000XCounselor
21041C0700XClinical Social WorkerL5981OR

General Provider Information

NPI Number : 1922147545
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ERIN BRADSHAW LCSW
Provider Business Mailing Address
First Line : 3945 SE HAWTHORNE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5241
Country : US
Telephone Number : 971-235-2613
Fax Number : 208-666-1642
Provider Business Practice Location Address
First Line : 3945 SE HAWTHORNE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5241
Country : US
Telephone Number : 971-235-2613
Fax Number : 208-666-1642
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 05/30/2014

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