MEDICARE: REBA EDWARDS 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	L17872	OR

General Provider Information

NPI Number	:	1255047171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBA EDWARDS LCSW

Provider Business Mailing Address
First Line	:	7515 FALCON CREST DR # 200
Second Line	:
City	:	REDMOND
State	:	OR
Zip	:	97756-5014
Country	:	US
Telephone Number	:	541-904-5216
Fax Number	:	541-527-4347

Provider Business Practice Location Address
First Line	:	12725 SW 66TH AVE STE 202
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-2500
Country	:	US
Telephone Number	:	503-953-0310
Fax Number	:

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

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	04/21/2026

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