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NPI Code Detail

MEDICARE: TARA CROWLEY

MEDICARE: TARA CROWLEY
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 Worker

General Provider Information

NPI Number : 1750677373
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA CROWLEY
Provider Business Mailing Address
First Line : PO BOX 12526
Second Line :
City : PORTLAND
State : OR
Zip : 97212-0526
Country : US
Telephone Number : 503-235-8057
Fax Number : 503-235-5455
Provider Business Practice Location Address
First Line : 5517 N COMMERCIAL AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97217-2339
Country : US
Telephone Number : 503-908-4532
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2011
Last Update Date : 05/25/2016

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Directions to “ TARA CROWLEY ” Practice Location

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