Healthcare Provider Details

I. General information

NPI: 1851757686
Provider Name (Legal Business Name): HEALTH MATTERS NORTHWEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 E BURNSIDE ST
PORTLAND OR
97214-1424
US

IV. Provider business mailing address

4442 SE NEHALEM ST
PORTLAND OR
97206-0952
US

V. Phone/Fax

Practice location:
  • Phone: 971-404-5174
  • Fax: 360-597-3706
Mailing address:
  • Phone: 971-404-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3057
License Number StateOR

VIII. Authorized Official

Name: CONSTANCE COQUILLETTE
Title or Position: PARTNER
Credential: LCSW
Phone: 971-404-5174