MEDICARE: MR. ROGER WILLIAM HUMBLE CADC1

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	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	05-07-17	OR

General Provider Information

NPI Number	:	1942346598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROGER WILLIAM HUMBLE CADC1

Provider Business Mailing Address
First Line	:	1011 COMMERCIAL ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-1049
Country	:	US
Telephone Number	:	503-983-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 COMMERCIAL ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-1049
Country	:	US
Telephone Number	:	503-983-9900
Fax Number	:	503-983-9899

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	11/01/2023

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