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General NPI Number Information
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NPI Number | 1457488074
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Entity Type | Individual
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Provider Name | LAURA W. BRYAN MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12744 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97233-1539
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Country | US
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Telephone | 503-282-1190
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13158
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City | PORTLAND
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State | OR
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Zip | 97213-0158
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Country | US
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Telephone | 503-282-1190
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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 | 1936
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00004805
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License Number State | WA
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