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General NPI Number Information
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NPI Number | 1962718700
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Entity Type | Individual
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Provider Name | MARIA E. WUNDERBRO LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 8196 SW HALL BLVD SUITE 202
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City | BEAVERTON
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State | OR
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Zip | 97008-6409
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Country | US
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Telephone | 503-567-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 SE 44TH AVE
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City | PORTLAND
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State | OR
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Zip | 97215-3125
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Country | US
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Telephone | 971-227-5067
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L6254
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License Number State | OR
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