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General NPI Number Information
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NPI Number | 1225593197
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Entity Type | Organization
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Legal Business Name | RECLAIM CLINIC
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 446 VILLA RD
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City | NEWBERG
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State | OR
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Zip | 97132-1856
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Country | US
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Telephone | 503-406-1009
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Fax |
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Provider Business Mailing Address
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Address Line | 470 N VILLA RD
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City | NEWBERG
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State | OR
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Zip | 97132-1858
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Country | US
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Telephone | 503-406-1009
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Fax | 503-200-2975
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Authorized Official
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Title or Position | OWNER
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Name | KATIE S NICOSIA
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Credential |
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Telephone | 503-406-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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