Healthcare Provider Details

I. General information

NPI: 1841735032
Provider Name (Legal Business Name): BARBARA L IDROGO CADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17645 NW SAINT HELENS RD
PORTLAND OR
97231-1729
US

IV. Provider business mailing address

1776 SW MADISON ST
PORTLAND OR
97206
US

V. Phone/Fax

Practice location:
  • Phone: 503-621-1069
  • Fax: 503-621-0200
Mailing address:
  • Phone: 971-386-2278
  • Fax: 503-224-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-16-447
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17-05-45
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: