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NPI Code Detail

MEDICARE: MEREDITH REDFERN

MEDICARE: MEREDITH REDFERN
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1215264049
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH REDFERN
Provider Business Mailing Address
First Line : 1904 SE DIVISION ST
Second Line :
City : PORTLAND
State : OR
Zip : 97202-1146
Country : US
Telephone Number : 503-517-8663
Fax Number :
Provider Business Practice Location Address
First Line : 1904 SE DIVISION ST
Second Line :
City : PORTLAND
State : OR
Zip : 97202-1146
Country : US
Telephone Number : 503-517-8663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2009
Last Update Date : 02/19/2016

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