MEDICARE: MS. LINDA LOUISE SISEMORE BS, CADC I

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	03-11-50	OR
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1861538225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA LOUISE SISEMORE BS, CADC I

Provider Business Mailing Address
First Line	:	12652 WOODPECKER DR SE
Second Line	:
City	:	TURNER
State	:	OR
Zip	:	97392-9731
Country	:	US
Telephone Number	:	503-399-7400
Fax Number	:	503-399-7575

Provider Business Practice Location Address
First Line	:	12652 WOODPECKER DR SE
Second Line	:
City	:	TURNER
State	:	OR
Zip	:	97392-9731
Country	:	US
Telephone Number	:	503-399-7400
Fax Number	:	503-399-7575

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	09/11/2025

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