MEDICARE: MS. GWENDOLYN M MORRIS MSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1811432255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GWENDOLYN M MORRIS MSW

Provider Business Mailing Address
First Line	:	PO BOX 844
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-0305
Country	:	US
Telephone Number	:	541-967-6580
Fax Number	:	541-926-1091

Provider Business Practice Location Address
First Line	:	1005 NW SPRINGHILL DR
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1748
Country	:	US
Telephone Number	:	541-967-6580
Fax Number	:	541-926-1091

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

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	12/20/2016

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