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General NPI Number Information
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NPI Number | 1184423584
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Entity Type | Organization
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Legal Business Name | WEST LINN CLEMENTINE, INC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 22035 S WISTERIA RD
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City | WEST LINN
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State | OR
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Zip | 97068-9231
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Country | US
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Telephone | 971-314-6530
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Fax | 971-228-1680
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Provider Business Mailing Address
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Address Line | 6100 SW 76TH ST
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5002
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Country | US
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Telephone |
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Fax | 305-740-4770
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Authorized Official
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Title or Position | CONTRACTING DIRECTOR
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Name | LAUREN LAU
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Credential |
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Telephone | 724-989-4564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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