Healthcare Provider Details

I. General information

NPI: 1043157977
Provider Name (Legal Business Name): SCOTT WILLIAM WOOLDRIDGE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SILVERTON RD NE
SALEM OR
97301-9710
US

IV. Provider business mailing address

780 MISSOURI AVE S
SALEM OR
97302-5567
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5351
  • Fax:
Mailing address:
  • Phone: 541-213-4702
  • Fax: 541-213-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201340570RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: