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General NPI Number Information
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NPI Number | 1124553797
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Entity Type | Organization
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Legal Business Name | ANDREA MIZE LLC
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 10175 SW BARBUR BLVD STE 300BG
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City | PORTLAND
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State | OR
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Zip | 97219-5909
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Country | US
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Telephone | 503-957-5947
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Fax | 503-206-0926
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Provider Business Mailing Address
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Address Line | 3 MONROE PKWY STE P 242
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-1486
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Country | US
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Telephone | 503-957-5947
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA L MIZE
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Credential | L.C.S.W.
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Telephone | 503-957-5947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7328
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License Number State | OR
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