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NPI Code Detail

MEDICARE: MS. SUSAN BAMFORD LCSW

MEDICARE: MS. SUSAN BAMFORD 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
1101YM0800XMental Health Counselor742OR

General Provider Information

NPI Number : 1073695508
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN BAMFORD LCSW
Provider Business Mailing Address
First Line : 7845 BURTON PL SE
Second Line :
City : SALEM
State : OR
Zip : 97301-9065
Country : US
Telephone Number : 503-581-7600
Fax Number : 503-581-6995
Provider Business Practice Location Address
First Line : 1845 COMMERCIAL ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-5203
Country : US
Telephone Number : 503-581-7600
Fax Number : 503-581-6995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 07/08/2007

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