MEDICARE: ASHLEY JORDAN PELTON

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1235610387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY JORDAN PELTON

Provider Business Mailing Address
First Line	:	PO BOX 3973
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-3973
Country	:	US
Telephone Number	:	503-730-1469
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 MADISON ST STE 106
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2354
Country	:	US
Telephone Number	:	503-730-1469
Fax Number	:

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

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	08/27/2018

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Directions to “ ASHLEY JORDAN PELTON ” Practice Location

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