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General NPI Number Information
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NPI Number | 1801398292
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Entity Type | Organization
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Legal Business Name | NORTHWEST INTEGRATED SENIOR SERVICES LLC
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 02/06/2021
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Provider Practice Location Address
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Address Line | 4531 SE BELMONT ST STE 107
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City | PORTLAND
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State | OR
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Zip | 97215-1675
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Country | US
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Telephone | 503-607-8855
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Fax | 503-296-2033
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Provider Business Mailing Address
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Address Line | 4531 SE BELMONT ST STE 107
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City | PORTLAND
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State | OR
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Zip | 97215-1675
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Country | US
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Telephone | 503-607-8855
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Fax | 503-296-2033
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Authorized Official
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Title or Position | MANAGER
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Name | DANA KAPPEN
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Credential | LCSW
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Telephone | 503-607-8855
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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 | L7548
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License Number State | OR
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