MEDICARE: DIANE JANEL POPP 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	2138	OR

General Provider Information

NPI Number	:	1427193473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE JANEL POPP LCSW

Provider Business Mailing Address
First Line	:	213 WATER AVE NW
Second Line	:	SUITE 400
City	:	ALBANY
State	:	OR
Zip	:	97321-2298
Country	:	US
Telephone Number	:	541-908-5011
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 WATER AVE NW
Second Line	:	SUITE 400
City	:	ALBANY
State	:	OR
Zip	:	97321-2298
Country	:	US
Telephone Number	:	541-908-5011
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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Directions to “ DIANE JANEL POPP LCSW” Practice Location

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