MEDICARE: GINGER BANDEEN

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	L3425	OR

General Provider Information

NPI Number	:	1760577738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINGER BANDEEN

Provider Business Mailing Address
First Line	:	3587 HEATHROW WAY
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-4004
Country	:	US
Telephone Number	:	541-858-8170
Fax Number	:

Provider Business Practice Location Address
First Line	:	17720 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-6734
Country	:	US
Telephone Number	:	503-654-7654
Fax Number	:	503-654-7333

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/06/2017

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Directions to “ GINGER BANDEEN ” Practice Location

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