Healthcare Provider Details

I. General information

NPI: 1336281922
Provider Name (Legal Business Name): NANCY ANNE MYERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 NE GREENWOOD AVE STE 3
BEND OR
97701-4513
US

IV. Provider business mailing address

320 SW CENTURY DR STE 405183
BEND OR
97702-3037
US

V. Phone/Fax

Practice location:
  • Phone: 925-451-6100
  • Fax: 925-775-7032
Mailing address:
  • Phone: 925-451-6100
  • Fax: 925-775-7032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19518
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL12057
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: