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General NPI Number Information
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NPI Number | 1710023247
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Entity Type | Organization
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Legal Business Name | OREGON SCOTTISH RITE CLINICS
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 5125 SW MACADAM AVE SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97239-3809
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Country | US
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Telephone | 503-226-1048
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 NE 80TH AVE
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City | PORTLAND
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State | OR
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Zip | 97218-4211
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Country | US
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Telephone | 503-282-2412
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PHILL LEVINSON
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Credential | PHD SLP
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Telephone | 503-226-1048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 235Z00000X
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License Number State | OR
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