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NPI Code Detail

MEDICARE: MS. SUSANNE GILLILAND-WILLIAMS

MEDICARE: MS. SUSANNE GILLILAND-WILLIAMS
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
1101Y00000XCounselor
2372600000XAdult Companion

General Provider Information

NPI Number : 1689926859
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSANNE GILLILAND-WILLIAMS
Provider Business Mailing Address
First Line : 2415 SE 43RD AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-1600
Country : US
Telephone Number : 503-674-7777
Fax Number :
Provider Business Practice Location Address
First Line : 847 NE 19TH AVE STE 160
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2686
Country : US
Telephone Number : 503-963-7791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2012
Last Update Date : 08/31/2013

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