Healthcare Provider Details

I. General information

NPI: 1922365295
Provider Name (Legal Business Name): PATRICIA I LAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA I PRITCHETT

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXCHANGE ST STE 301
ASTORIA OR
97103-3364
US

IV. Provider business mailing address

65 N HIGHWAY 101 STE 204
WARRENTON OR
97146-9371
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-5722
  • Fax: 503-861-2043
Mailing address:
  • Phone: 503-325-5722
  • Fax: 503-861-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7982
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: