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NPI Code Detail

MEDICARE: FATIMA JALLOH

MEDICARE: FATIMA JALLOH
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 Worker70069541WA
21041C0700XClinical Social WorkerL11796OR

General Provider Information

NPI Number : 1922612035
Entity Type Code : Individual
Provider Name (Legal Business Name) : FATIMA JALLOH
Provider Business Mailing Address
First Line : PO BOX 1121
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-0254
Country : US
Telephone Number : 541-440-3532
Fax Number : 541-440-3554
Provider Business Practice Location Address
First Line : 16811 SE MCGILLIVRAY BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-3404
Country : US
Telephone Number : 360-735-8100
Fax Number : 360-253-1781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2020
Last Update Date : 06/03/2026

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Directions to “ FATIMA JALLOH ” Practice Location

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