MEDICARE: JANE THARPE NORMAN

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	101YM0800X	Mental Health Counselor	L1253	OR

General Provider Information

NPI Number	:	1548284565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE THARPE NORMAN

Provider Business Mailing Address
First Line	:	17051 CRESTVIEW DR
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-5871
Country	:	US
Telephone Number	:	503-757-2722
Fax Number	:	503-636-2129

Provider Business Practice Location Address
First Line	:	17051 CRESTVIEW DR
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-5871
Country	:	US
Telephone Number	:	503-757-2722
Fax Number	:	503-636-2129

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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