MEDICARE: ALIX ELIZABETH LAND LCSW

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	L2428	OR

General Provider Information

NPI Number	:	1871795534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIX ELIZABETH LAND LCSW

Provider Business Mailing Address
First Line	:	1020 SW TAYLOR ST STE 535
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2527
Country	:	US
Telephone Number	:	503-827-4303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST STE 535
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2527
Country	:	US
Telephone Number	:	503-827-4303
Fax Number	:

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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Directions to “ ALIX ELIZABETH LAND LCSW” Practice Location

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