=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518035989
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN E SPEARS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 02/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 NE 15TH ST
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-2210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-703-1402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5440 PALISADES DR
-----------------------------------------------------
City | LINCOLN CITY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97367-4529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-703-1402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2743
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------