MEDICARE: HENRY WEDDLE

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	A13892	OR

General Provider Information

NPI Number	:	1811661176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY WEDDLE

Provider Business Mailing Address
First Line	:	1001 MOLALLA AVE STE 209
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-3768
Country	:	US
Telephone Number	:	971-430-0727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 MOLALLA AVE STE 209
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-3768
Country	:	US
Telephone Number	:	971-430-0727
Fax Number	:

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

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	07/06/2023

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