=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104124445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA MARIE RICE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2011
-----------------------------------------------------
Last Update Date | 09/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 RANCH RD
-----------------------------------------------------
City | REEDSPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97467-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-271-2163
-----------------------------------------------------
Fax | 541-271-4058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 RANCH RD
-----------------------------------------------------
City | REEDSPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97467-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-271-2163
-----------------------------------------------------
Fax | 541-271-4058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW-30413
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | L6211
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------