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NPI Code Detail

MEDICARE: MS. BARBARA ALISON PANKO QMHP

MEDICARE: MS. BARBARA ALISON PANKO QMHP
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
1101Y00000XCounselor19-QMHPC-08110OR

General Provider Information

NPI Number : 1184942518
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BARBARA ALISON PANKO QMHP
Provider Business Mailing Address
First Line : 1507 NE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-1911
Country : US
Telephone Number : 415-939-1243
Fax Number :
Provider Business Practice Location Address
First Line : 1507 NE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-1911
Country : US
Telephone Number : 971-917-6969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2010
Last Update Date : 04/04/2024

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