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General NPI Number Information
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NPI Number | 1518060805
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Entity Type | Individual
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Provider Name | MICHAEL VERNON EDDINGTON MSW,LICSW
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | VA MEDICAL CENTER(V3CNH) SAM JACKSON BLVD
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City | PORTLAND
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State | OR
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Zip | 97207
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Country | US
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Telephone | 503-220-8262
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Fax |
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Provider Business Mailing Address
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Address Line | 20520 NE 221ST CIR
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4922
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Country | US
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Telephone | 360-666-5545
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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 | LW00005125
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License Number State | WA
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