Healthcare Provider Details

I. General information

NPI: 1366830879
Provider Name (Legal Business Name): ELIZABETH C SCHEELER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CONNELLY

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW FRAZER AVE STE 111
PENDLETON OR
97801-2800
US

IV. Provider business mailing address

43395 HEAVENS LN
PENDLETON OR
97801-9490
US

V. Phone/Fax

Practice location:
  • Phone: 541-969-9195
  • Fax:
Mailing address:
  • Phone: 541-969-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7909
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: