MEDICARE: AGNES ABEL 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
1	1041C0700X	Clinical Social Worker	1195	OR

General Provider Information

NPI Number	:	1114079696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES ABEL LCSW

Provider Business Mailing Address
First Line	:	1911 MT VIEW LN
Second Line	:	#500
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2248
Country	:	US
Telephone Number	:	503-357-0206
Fax Number	:	503-357-9003

Provider Business Practice Location Address
First Line	:	1911 MT VIEW LN
Second Line	:	#500
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2248
Country	:	US
Telephone Number	:	503-357-0206
Fax Number	:	503-357-9003

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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