=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134411994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHILO CARAMAY SMITH L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2011
-----------------------------------------------------
Last Update Date | 04/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 SE 2ND ST
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801-2224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-276-6207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 546 SE 204TH PL
-----------------------------------------------------
City | GRESHAM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97030-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-373-3900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 4958
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------