Healthcare Provider Details

I. General information

NPI: 1700822756
Provider Name (Legal Business Name): BEATRICE A FIFER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISS A FIFER LCSW

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SW 11TH AVE 913
PORTLAND OR
97205-2125
US

IV. Provider business mailing address

833 SW 11TH AVE 913
PORTLAND OR
97205-2125
US

V. Phone/Fax

Practice location:
  • Phone: 503-222-2420
  • Fax: 503-222-5395
Mailing address:
  • Phone: 503-222-2420
  • Fax: 503-222-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number#1698
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: