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NPI Code Detail

MEDICARE: MS. DENA RUBY WELLINGTON MSW, LCSW

MEDICARE: MS. DENA RUBY WELLINGTON MSW, 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
11041C0700XClinical Social WorkerL10563OR

General Provider Information

NPI Number : 1891817680
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DENA RUBY WELLINGTON MSW, LCSW
Provider Business Mailing Address
First Line : 14630 NW PERIMETER DR
Second Line :
City : BEAVERTON
State : OR
Zip : 97006-5422
Country : US
Telephone Number : 503-936-8646
Fax Number :
Provider Business Practice Location Address
First Line : 11740 SW 68TH PKWY STE 200
Second Line :
City : TIGARD
State : OR
Zip : 97223-9058
Country : US
Telephone Number : 503-205-4357
Fax Number : 503-230-1371
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 08/09/2022

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