Healthcare Provider Details

I. General information

NPI: 1114661899
Provider Name (Legal Business Name): CHAD EMMANUEL EADDY MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NE MARKET DR
FAIRVIEW OR
97024-7000
US

IV. Provider business mailing address

1800 NE MARKET DR
FAIRVIEW OR
97024-7000
US

V. Phone/Fax

Practice location:
  • Phone: 503-660-0600
  • Fax:
Mailing address:
  • Phone: 503-660-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: