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NPI Code Detail

MEDICARE: MRS. ABIGAIL SUSANNE DEMCHAK

MEDICARE: MRS. ABIGAIL SUSANNE DEMCHAK
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
1101YM0800XMental Health Counselor
2104100000XSocial WorkerL11038OR

General Provider Information

NPI Number : 1043791270
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ABIGAIL SUSANNE DEMCHAK
Provider Business Mailing Address
First Line : PO BOX 1189
Second Line :
City : CORVALLIS
State : OR
Zip : 97339-1189
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 675 N 5TH ST
Second Line :
City : LEBANON
State : OR
Zip : 97355-2875
Country : US
Telephone Number : 541-451-6282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2018
Last Update Date : 03/11/2026

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