Healthcare Provider Details

I. General information

NPI: 1104539576
Provider Name (Legal Business Name): MEGAN NIETO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MAIN ST STE B-207
OREGON CITY OR
97045-1826
US

IV. Provider business mailing address

1800 BLANKENSHIP RD STE 448
WEST LINN OR
97068-4191
US

V. Phone/Fax

Practice location:
  • Phone: 971-806-0221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

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: