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NPI Code Detail

MEDICARE: MRS. LAURA LEE POWELL CADC II

MEDICARE: MRS. LAURA LEE POWELL CADC II
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) CounselorOR

General Provider Information

NPI Number : 1386782530
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA LEE POWELL CADC II
Provider Business Mailing Address
First Line : 18345 NE GLISAN ST UNIT 11
Second Line :
City : PORTLAND
State : OR
Zip : 97230-7273
Country : US
Telephone Number : 503-669-0169
Fax Number :
Provider Business Practice Location Address
First Line : 5139 N LOMBARD ST
Second Line :
City : PORTLAND
State : OR
Zip : 97203-4403
Country : US
Telephone Number : 503-285-9871
Fax Number : 503-978-8640
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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