Healthcare Provider Details

I. General information

NPI: 1922245216
Provider Name (Legal Business Name): CYNTHIA ANN MCQUADE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA ANN JOHNSON-ROSE

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 NW GRANT AVE
CORVALLIS OR
97330
US

IV. Provider business mailing address

2075 NW GRANT AVE
CORVALLIS OR
97330-4366
US

V. Phone/Fax

Practice location:
  • Phone: 541-368-3152
  • Fax: 855-279-0612
Mailing address:
  • Phone: 541-368-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6125
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: