MEDICARE: MRS. MOLLY C BAIR CADCII,

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	04-R-13	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285798660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MOLLY C BAIR CADCII,

Provider Business Mailing Address
First Line	:	PO BOX 82819
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97282-0819
Country	:	US
Telephone Number	:	503-233-5405
Fax Number	:	503-233-2696

Provider Business Practice Location Address
First Line	:	880 82ND DR
Second Line	:
City	:	GLADSTONE
State	:	OR
Zip	:	97027-1803
Country	:	US
Telephone Number	:	503-659-5515
Fax Number	:	503-659-1994

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	06/11/2008

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