MEDICARE: KARL P PISTER 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	1564	OR

General Provider Information

NPI Number	:	1184781726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL P PISTER LCSW

Provider Business Mailing Address
First Line	:	10175 SW BARBUR BLVD
Second Line	:	SUITE 300BL
City	:	PORTLAND
State	:	OR
Zip	:	97219-5908
Country	:	US
Telephone Number	:	503-796-9694
Fax Number	:	503-981-8584

Provider Business Practice Location Address
First Line	:	10175 SW BARBUR BLVD
Second Line	:	SUITE 300BL
City	:	PORTLAND
State	:	OR
Zip	:	97219-5908
Country	:	US
Telephone Number	:	503-796-9694
Fax Number	:	503-981-8584

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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