MEDICARE: MARGARET BAULSIR CADC-R

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	T-24-3696	OR

General Provider Information

NPI Number	:	1518717578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET BAULSIR CADC-R

Provider Business Mailing Address
First Line	:	11022 SE WOOD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-4553
Country	:	US
Telephone Number	:	503-951-8104
Fax Number	:	541-234-3777

Provider Business Practice Location Address
First Line	:	11022 SE WOOD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-4553
Country	:	US
Telephone Number	:	503-951-8104
Fax Number	:	541-234-3777

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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