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NPI Code Detail

MEDICARE: MS. SUSAN MARGARET TREZISE

MEDICARE: MS. SUSAN MARGARET TREZISE
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1588917033
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN MARGARET TREZISE
Provider Business Mailing Address
First Line : 5119 NE 57TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97218-2584
Country : US
Telephone Number : 503-215-8060
Fax Number : 503-215-8082
Provider Business Practice Location Address
First Line : 5119 NE 57TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97218-2584
Country : US
Telephone Number : 503-215-8060
Fax Number : 503-215-8082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2012
Last Update Date : 10/22/2012

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Directions to “ MS. SUSAN MARGARET TREZISE ” Practice Location

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