Healthcare Provider Details

I. General information

NPI: 1215241088
Provider Name (Legal Business Name): SUE ANN IMHOFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SE 2ND ST
PENDLETON OR
97801-2224
US

IV. Provider business mailing address

2206 SW QUINNEY DR
PENDLETON OR
97801-4442
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-6207
  • Fax:
Mailing address:
  • Phone: 541-276-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4627
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: