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NPI Code Detail

MEDICARE: MRS. KIM CHING FILLA LCSW

MEDICARE: MRS. KIM CHING FILLA LCSW
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
11041C0700XClinical Social Worker4168OR

General Provider Information

NPI Number : 1679700397
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIM CHING FILLA LCSW
Provider Business Mailing Address
First Line : 12711 NE 46TH ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98682-6402
Country : US
Telephone Number : 971-570-7624
Fax Number :
Provider Business Practice Location Address
First Line : 1305 NE FREMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97212-2218
Country : US
Telephone Number : 971-570-7624
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2009
Last Update Date : 06/20/2009

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