MEDICARE: DARREN MICHAEL NEALIS LICSW

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	LW60065730	WA

General Provider Information

NPI Number	:	1912929258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN MICHAEL NEALIS LICSW

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18313 PAULSON ST SW STE A
Second Line	:
City	:	ROCHESTER
State	:	WA
Zip	:	98579-9262
Country	:	US
Telephone Number	:	360-827-8400
Fax Number	:	360-273-7301

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	02/13/2023

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