MEDICARE: ABBIE JO NEDERHOED 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

General Provider Information

NPI Number	:	1508257254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBIE JO NEDERHOED LCSW

Provider Business Mailing Address
First Line	:	2000 NE 42ND AVE # 1058
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1399
Country	:	US
Telephone Number	:	503-765-9995
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 NE 42ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-1609
Country	:	US
Telephone Number	:	503-765-9995
Fax Number	:

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

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	01/11/2024

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