MEDICARE: JACQUELINE ARMSTRONG MOORE 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
1	1041C0700X	Clinical Social Worker	L11632	OR

General Provider Information

NPI Number	:	1750151825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ARMSTRONG MOORE LCSW

Provider Business Mailing Address
First Line	:	4800 S MACADAM AVE STE 230
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3927
Country	:	US
Telephone Number	:	518-570-0149
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 S MACADAM AVE STE 230
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3927
Country	:	US
Telephone Number	:	971-266-2042
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	11/29/2024

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