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General NPI Number Information
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NPI Number | 1912336140
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Entity Type | Individual
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Provider Name | NANCY LEE MACKLIN M.S.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 948 NE 102ND AVE STE 101
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City | PORTLAND
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State | OR
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Zip | 97220-4064
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Country | US
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Telephone | 503-257-0381
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Fax |
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Provider Business Mailing Address
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Address Line | 3738 NW 3RD AVE
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City | CAMAS
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State | WA
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Zip | 98607-8321
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Country | US
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Telephone | 360-834-9399
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | IN
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