MEDICARE: RILEY O'DONNELL

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

General Provider Information

NPI Number	:	1639007057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY O'DONNELL

Provider Business Mailing Address
First Line	:	428 N VILLA RD
Second Line	:
City	:	NEWBERG
State	:	OR
Zip	:	97132-1855
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 N VILLA RD
Second Line	:
City	:	NEWBERG
State	:	OR
Zip	:	97132-1855
Country	:	US
Telephone Number	:	503-208-6643
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “ RILEY O'DONNELL ” Practice Location

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