MEDICARE: FROUKJE TRIJNTJE SPAAK-POWELL

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	14-12-39	OR

General Provider Information

NPI Number	:	1396287678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FROUKJE TRIJNTJE SPAAK-POWELL

Provider Business Mailing Address
First Line	:	35417 TENNESSEE RD SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-9737
Country	:	US
Telephone Number	:	541-905-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 NW SPRINGHILL DR
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1748
Country	:	US
Telephone Number	:	541-967-6580
Fax Number	:

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

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	11/17/2016

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