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NPI Code Detail

MEDICARE: JUDY A IRVIN L.C.S.W

MEDICARE: JUDY A IRVIN L.C.S.W
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 WorkerL3159OR

General Provider Information

NPI Number : 1871599134
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY A IRVIN L.C.S.W
Provider Business Mailing Address
First Line : 1845 COMMERCIAL ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-5203
Country : US
Telephone Number : 503-315-2041
Fax Number :
Provider Business Practice Location Address
First Line : 1845 COMMERCIAL ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-5203
Country : US
Telephone Number : 503-315-2041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 07/08/2007

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