Healthcare Provider Details

I. General information

NPI: 1306753090
Provider Name (Legal Business Name): NORTHWEST HUMAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 EDGEWATER ST NW
SALEM OR
97304-4049
US

IV. Provider business mailing address

681 CENTER ST NE
SALEM OR
97301-3722
US

V. Phone/Fax

Practice location:
  • Phone: 503-378-7526
  • Fax: 503-480-1611
Mailing address:
  • Phone: 503-588-5828
  • Fax: 503-588-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY LEATHLEY
Title or Position: CEO
Credential:
Phone: 503-588-5828