MEDICARE: TEAGAN S MARTEL 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	089.0135035	VT
2	1041C0700X	Clinical Social Worker	L14173	OR

General Provider Information

NPI Number	:	1386219608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEAGAN S MARTEL LCSW

Provider Business Mailing Address
First Line	:	2187 SW MAIN ST STE 10
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1123
Country	:	US
Telephone Number	:	802-230-4442
Fax Number	:	502-218-5299

Provider Business Practice Location Address
First Line	:	2187 SW MAIN ST STE 10
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1123
Country	:	US
Telephone Number	:	802-230-4442
Fax Number	:	502-218-5299

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

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	02/28/2026

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Directions to “ TEAGAN S MARTEL LCSW” Practice Location

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