MEDICARE: MRS. CARRIE LAINE TOWNSEND QMHA

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1578497632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE LAINE TOWNSEND QMHA

Provider Business Mailing Address
First Line	:	907 NE BALDWIN ST
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-2516
Country	:	US
Telephone Number	:	877-303-1950
Fax Number	:	503-914-0994

Provider Business Practice Location Address
First Line	:	3901 SE NAEF RD STE 424
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97267-5616
Country	:	US
Telephone Number	:	877-303-1950
Fax Number	:	503-914-0994

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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