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General NPI Number Information
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NPI Number | 1992049258
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Entity Type | Individual
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Provider Name | ALLISON RAE SUPNICK MSW
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Gender | Female
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 14025 SW FARMINGTON RD SUITE 160
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City | BEAVERTON
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State | OR
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Zip | 97005-2512
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Country | US
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Telephone | 503-258-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 14025 SW FARMINGTON RD SUITE 160
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City | BEAVERTON
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State | OR
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Zip | 97005-2512
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Country | US
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Telephone | 503-807-3083
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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