MEDICARE: REBECCA SOUPIR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11387	OR

General Provider Information

NPI Number	:	1003687252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA SOUPIR LCSW

Provider Business Mailing Address
First Line	:	2206 1ST ST
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-1705
Country	:	US
Telephone Number	:	541-975-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612 5TH ST
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-2516
Country	:	US
Telephone Number	:	541-975-4488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/15/2024

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Directions to “ REBECCA SOUPIR LCSW” Practice Location

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