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General NPI Number Information
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NPI Number | 1619647096
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Entity Type | Individual
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Provider Name | NATALIA MOODY
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/15/2024
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Provider Practice Location Address
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Address Line | 3439 SE HAWTHORNE BLVD # 1044
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City | PORTLAND
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State | OR
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Zip | 97214-5048
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Country | US
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Telephone | 971-309-1780
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Fax |
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Provider Business Mailing Address
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Address Line | 6510 SW 21ST AVE
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City | PORTLAND
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State | OR
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Zip | 97239-1916
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Country | US
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Telephone | 56-416-6862
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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 | A15573
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License Number State | OR
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