MEDICARE: JUSTINE STRACH ELSTAD CSWA

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	104100000X	Social Worker	54067	TX
2	104100000X	Social Worker	A3195	OR

General Provider Information

NPI Number	:	1063775799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE STRACH ELSTAD CSWA

Provider Business Mailing Address
First Line	:	14600 NW CORNELL RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-5442
Country	:	US
Telephone Number	:	503-645-3581
Fax Number	:	503-690-9605

Provider Business Practice Location Address
First Line	:	4105 SE INTERNATIONAL WAY STE 501
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-8855
Country	:	US
Telephone Number	:	503-645-3581
Fax Number	:	503-690-9605

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	02/25/2016

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