Healthcare Provider Details

I. General information

NPI: 1235336116
Provider Name (Legal Business Name): VICTORIA POHL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 PRIMROSE LOOP APT A
PHILOMATH OR
97370-9540
US

IV. Provider business mailing address

2319 PRIMROSE LOOP APT A
PHILOMATH OR
97370-9540
US

V. Phone/Fax

Practice location:
  • Phone: 503-963-7765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
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: