MEDICARE: MR. MATTHEW LOVETT TALLMAN CRM

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	1041C0700X	Clinical Social Worker	L18060	OR

General Provider Information

NPI Number	:	1083078083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW LOVETT TALLMAN CRM

Provider Business Mailing Address
First Line	:	5441 S MACADAM AVE STE R
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3822
Country	:	US
Telephone Number	:	503-753-0243
Fax Number	:

Provider Business Practice Location Address
First Line	:	6904 N KNOWLES AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5117
Country	:	US
Telephone Number	:	503-753-0243
Fax Number	:

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

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	06/08/2026

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