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General NPI Number Information
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NPI Number | 1851757686
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Entity Type | Organization
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Legal Business Name | HEALTH MATTERS NORTHWEST, LLC
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1312 E BURNSIDE ST
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City | PORTLAND
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State | OR
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Zip | 97214-1424
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Country | US
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Telephone | 971-404-5174
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Fax | 360-597-3706
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Provider Business Mailing Address
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Address Line | 4442 SE NEHALEM ST
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City | PORTLAND
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State | OR
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Zip | 97206-0952
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Country | US
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Telephone | 971-404-5174
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | CONSTANCE COQUILLETTE
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Credential | LCSW
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Telephone | 971-404-5174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L3057
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License Number State | OR
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