MEDICARE: JANICE C. PREMO

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	101YP2500X	Professional Counselor	2044	OR
2	101YP2500X	Professional Counselor	85365	OR
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	07-09-36	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07-09-36	OTHER	OR	CADC1

General Provider Information

NPI Number	:	1518146802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE C. PREMO

Provider Business Mailing Address
First Line	:	6400 SE LAKE RD STE 102
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-2129
Country	:	US
Telephone Number	:	503-810-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 SE LAKE RD STE 102
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-2129
Country	:	US
Telephone Number	:	503-810-8111
Fax Number	:

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

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/04/2007

Similar Medicare Providers

1619973070 — DR. TERRY L ISOM DMD
Practice Location Address:

6400 SE LAKE RD , SUITE 140
PORTLAND, OR
97222-2129

Practice Phone: 503-496-4766
Practice Fax: 503-496-4700

1588635635 — MR. WILLIAM C. WHITACRE CRNA
Practice Location Address:

6400 SE LAKE RD STE 130
PORTLAND, OR
97222-2129

Practice Phone: 503-594-1774
Practice Fax: 503-594-1775

1124112842 — MR. CRAIG G KLEIV CRNA
Practice Location Address:

6400 SE LAKE RD STE 300
PORTLAND, OR
97222-2129

Practice Phone: 503-594-1774
Practice Fax:

1497930432 — LANDON SESSIONS CRNA
Practice Location Address:

6400 SE LAKE RD , SUITE 109
PORTLAND, OR
97222-2129

Practice Phone: 503-594-1774
Practice Fax: 503-594-1775

1427447143 — AT HOME PRIMARY CARE LLC.
Practice Location Address:

6400 SE LAKE RD # 420
PORTLAND, OR
97222-2129

Practice Phone: 503-344-6717
Practice Fax:

1992188445 — NATASHA LAUREN HARRISON
Practice Location Address:

6400 SE LAKE RD
PORTLAND, OR
97222-2129

Practice Phone: 541-213-1226
Practice Fax:

Directions to “ JANICE C. PREMO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.