MEDICARE: OWEN FAYE WARDROP

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	101Y00000X	Counselor
2	104100000X	Social Worker	L16261	OR
3	104100000X	Social Worker		OR

General Provider Information

NPI Number	:	1033720511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OWEN FAYE WARDROP

Provider Business Mailing Address
First Line	:	1327 SE TACOMA ST STE 307
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-6639
Country	:	US
Telephone Number	:	504-545-8465
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 SE DIVISION ST
Second Line	:	STE 520
City	:	PORTLAND
State	:	OR
Zip	:	97214-9721
Country	:	US
Telephone Number	:	503-506-0441
Fax Number	:

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	04/14/2025

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Directions to “ OWEN FAYE WARDROP ” Practice Location

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