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General NPI Number Information
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NPI Number | 1518001734
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Entity Type | Individual
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Provider Name | REGINA E VANDER LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 4742 LIBERTY RD. S. #525
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City | SALEM
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State | OR
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Zip | 97302-5037
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Country | US
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Telephone | 503-858-5867
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Fax | 503-815-2383
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Provider Business Mailing Address
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Address Line | 4742 LIBERTY RD. S. #525
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City | SALEM
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State | OR
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Zip | 97302-5037
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Country | US
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Telephone | 503-858-5867
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Fax | 503-815-2383
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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 | L3859
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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 | 3859
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License Number State | OR
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