MEDICARE: FAWN AND YARROW COUNSELING LLC

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

General Provider Information

NPI Number	:	1881541050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAWN AND YARROW COUNSELING LLC

Provider Business Mailing Address
First Line	:	4936 SE WOODSTOCK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6163
Country	:	US
Telephone Number	:	503-395-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	4936 SE WOODSTOCK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6163
Country	:	US
Telephone Number	:	503-395-0029
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALICE HACKER
Credential	:	LCSW
Telephone Number	:	503-395-0029

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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