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NPI Code Detail

MEDICARE: ANDULIA WHITE ELK CADCI

MEDICARE: ANDULIA WHITE ELK CADCI
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
1101YA0400XAddiction (Substance Use Disorder) Counselor050757OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053302554
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDULIA WHITE ELK CADCI
Provider Business Mailing Address
First Line : 1776 SW MADISON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97205-1715
Country : US
Telephone Number : 503-231-2641
Fax Number : 503-231-1654
Provider Business Practice Location Address
First Line : 1631 SW COLUMBIA ST
Second Line :
City : PORTLAND
State : OR
Zip : 97201-6025
Country : US
Telephone Number : 503-231-2641
Fax Number : 503-231-1654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 07/08/2007

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Directions to “ ANDULIA WHITE ELK CADCI” Practice Location

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