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General NPI Number Information
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NPI Number | 1912228982
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Entity Type | Individual
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Provider Name | MEGAN JEAN WACKFORD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 10180 SE SUNNYSIDE RD
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City | CLACKAMAS
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State | OR
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Zip | 97015-8970
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Country | US
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Telephone | 503-652-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 14679 SE CHRISTINA CT
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City | CLACKAMAS
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State | OR
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Zip | 97015-8460
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Country | US
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Telephone | 541-543-7192
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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 | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | RT-P-10121226
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License Number State | OR
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