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General NPI Number Information
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NPI Number | 1366963860
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Entity Type | Individual
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Provider Name | LAUREN AUGUST CONN CSWA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 2801 N GANTENBEIN AVE
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City | PORTLAND
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State | OR
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Zip | 97227-1623
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Country | US
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Telephone | 503-415-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 NE 75TH AVE # 2
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City | PORTLAND
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State | OR
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Zip | 97213-6124
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Country | US
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Telephone | 503-830-7302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A13467
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | THW00079
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License Number State | OR
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