MEDICARE: MS. LORENE MARIE CALLAHAN MSW

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

General Provider Information

NPI Number	:	1124446752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORENE MARIE CALLAHAN MSW

Provider Business Mailing Address
First Line	:	1244 NE HACIENDA LN
Second Line	:
City	:	GRESHAM
State	:	OR
Zip	:	97030-4634
Country	:	US
Telephone Number	:	503-544-3547
Fax Number	:

Provider Business Practice Location Address
First Line	:	4134 N VANCOUVER AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2900
Country	:	US
Telephone Number	:	503-331-2548
Fax Number	:

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

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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